{ "hospital_name": "East Liverpool City Hospital", "last_updated_on": "2026-03-17", "version": "3.0", "location_name": [ "East Liverpool City Hospital" ], "hospital_address": [ "425 West Fifth Street East Liverpool, OH 43920" ], "license_information": { "license_number": "340714583", "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": [ "1659375673" ], "standard_charge_information": [ { "description": "#CFP-4502 ITEM# 053736", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 194.46, "10th_percentile": 194.46, "90th_percentile": 194.46, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 232.43, "10th_percentile": 232.43, "90th_percentile": 232.43, "count": "1 through 10" } ] } ] }, { "description": "0.9 Ns - 00264780020", "drug_information": { "unit": 250.0, "type": "ML" }, "code_information": [ { "code": "00264780020", "type": "NDC" }, { "code": "J7050", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 51.06, "10th_percentile": 51.06, "90th_percentile": 51.06, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 43.55, "10th_percentile": 43.55, "90th_percentile": 43.55, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 151.52, "10th_percentile": 151.52, "90th_percentile": 151.52, "count": "1 through 10" } ] } ] }, { "description": "(CALR) MUTATION ANALAYSIS", "code_information": [ { "code": "81219", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 875.0, "discounted_cash": 121.0, "minimum": 40.3459, "maximum": 857.5, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 121.63, "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": 194.61, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 125.28, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 125.28, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 176.36, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 130.14, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 127.71, "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": 170.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 176.36, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 182.08, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 145.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 133.79, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 180.26, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 112.76 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 176.62, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 121.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 121.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 119.2, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 121.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 130.14, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 181.84, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": ".062 K-WIRE #164206062", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 194.46, "10th_percentile": 194.46, "90th_percentile": 194.46, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 232.43, "10th_percentile": 232.43, "90th_percentile": 232.43, "count": "1 through 10" } ] } ] }, { "description": "> 100 SQCM ADDL 100 SQCM TRUNK", "code_information": [ { "code": "15274", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 583.32, "minimum": 174.996, "maximum": 583.32, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 391.5 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 384.05 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 372.86 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 380.32 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 372.86 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 384.05 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 583.32 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 372.86 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 391.5 } ] } ] }, { "description": ">100 SQCM 1ST 100SQCM 1%", "code_information": [ { "code": "15273", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13830.7, "discounted_cash": 1942.0, "minimum": 372.86, "maximum": 13830.7, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 391.5 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 384.05 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1942.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 1942.46, "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": 3107.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 372.86 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1942.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 380.32 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 2000.73, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 2000.73, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2816.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2078.43, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 2039.58, "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": 2719.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1942.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1942.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2816.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 372.86 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1942.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2907.86, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2330.95, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 384.05 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2136.71, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2878.73, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1973.35 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2820.65, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 372.86 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1942.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1942.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 1942.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 391.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.61, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1942.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2078.43, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2903.98, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "1/3 TUBULAR PLATE, 6 HOLE", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "1.7MM CABLE W/ CRIMP 750MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "0.9 Ns - 00338004903", "drug_information": { "unit": 500.0, "type": "ML" }, "code_information": [ { "code": "00338004903", "type": "NDC" }, { "code": "J7040", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 42.26, "10th_percentile": 42.25, "90th_percentile": 42.26, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 51.06, "10th_percentile": 51.06, "90th_percentile": 51.06, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 47.63, "10th_percentile": 47.63, "90th_percentile": 47.63, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 47.63, "10th_percentile": 47.63, "90th_percentile": 47.63, "count": "13" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 50.51, "10th_percentile": 50.51, "90th_percentile": 101.01, "count": "18" } ] } ] }, { "description": "0.9 Ns - 00264780000", "drug_information": { "unit": 1000.0, "type": "ML" }, "code_information": [ { "code": "00264780000", "type": "NDC" }, { "code": "J7030", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 2.47, "10th_percentile": 1.95, "90th_percentile": 48.55, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 58.67, "10th_percentile": 58.67, "90th_percentile": 58.67, "count": "48" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 54.72, "10th_percentile": 52.82, "90th_percentile": 54.72, "count": "61" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 58.03, "10th_percentile": 58.03, "90th_percentile": 58.03, "count": "109" } ] } ] }, { "description": "11 X 300 MM TIBIAL NAIL", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "11 BETA PROSTAGLANDIN F2 ALPHA", "code_information": [ { "code": "84150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1090.0, "discounted_cash": 41.0, "minimum": 37.1962, "maximum": 1396.5, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 41.77, "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": 66.83, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 43.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 43.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 60.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 44.69, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 43.86, "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": 58.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 60.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 62.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 50.12, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 45.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 61.9, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 37.2 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 60.65, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 41.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 41.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.93, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 41.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 44.69, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.59 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.45, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "1.5mm Cortex screw slftpng T4 - C1713 - 2785073", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "112026 Screw BN 4MM 6MM 46MM L", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "135 DEG DHS PL-SH BARREL 2H/46", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "1/3 TUBULAR PLATE 8 HOLE/L95M", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "12/130 DEG TI CAN TROCH NAIL 1", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "1ST 25 SQCM UP TO 100 SQCM LEG", "code_information": [ { "code": "C5271", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2414.45, "discounted_cash": 564.0, "minimum": 372.86, "maximum": 2366.161, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 391.5 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 384.05 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 564.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 564.06, "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": 902.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 372.86 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 564.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 380.32 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 580.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 580.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 817.89, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 603.54, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 592.26, "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": 789.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 564.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 564.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 817.89, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 372.86 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 564.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 844.4, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 676.87, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 384.05 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 620.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 835.94, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1973.35 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 819.07, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 372.86 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 564.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 564.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 564.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 391.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 552.78, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 564.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 603.54, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 843.27, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "1.5mm LCP ext H-Plate Left wit", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "112091 Screw BN 7.3mm 45mm 16m", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "12MM 130 DEGREE CANN TFNA 170M", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "2.3X11MM BONE SCREWSCROSSPINSE", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "1.8MM QFIX ASA W/1 MT CB WH", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "112109 Screw BN 7.3mm 8.2mm 75", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "17-HYDROXYPREGNENOLONE", "code_information": [ { "code": "84143", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 133.56, "discounted_cash": 22.0, "minimum": 19.2326, "maximum": 130.8888, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.04 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.45 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 36.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.56 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.15 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 24.41, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 29.56 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 34.15, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 27.37, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.45 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 25.09, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 33.8, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 29.56 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 33.12, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.56 }, { "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 Duals", "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": 31.04 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.35, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.53 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.1, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "2.4 CORTICAL SCREW #201.640", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 194.46, "10th_percentile": 194.46, "90th_percentile": 194.46, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 232.43, "10th_percentile": 232.43, "90th_percentile": 232.43, "count": "1 through 10" } ] } ] }, { "description": "10/130 DEG TI CANN TFNA 420 RI", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "112254 WSHR 7mm 3.6mm SM LCP", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "18-Hydroxycorticosterone", "code_information": [ { "code": "82542", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 300.35, "discounted_cash": 24.0, "minimum": 13.68, "maximum": 1960.0, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 112.32, "10th_percentile": 112.32, "90th_percentile": 159.12, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 38.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 25.78, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 36.06, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 28.91, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 26.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 35.7, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 34.98, "additional_payer_notes": "145.21% 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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 376.2, "10th_percentile": 376.2, "90th_percentile": 376.2, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 23.61, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.68 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.01, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "2.4MM 6 HOLE PLATE #249.906", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 194.46, "10th_percentile": 194.46, "90th_percentile": 194.46, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 232.43, "10th_percentile": 232.43, "90th_percentile": 232.43, "count": "1 through 10" } ] } ] }, { "description": "12/130 DEG TI CANN TFNA 400MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "135 DEG DHS PLATE 2 HOLE 46MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "1ST 25 SQ CM TO 100 SQ CM FEET", "code_information": [ { "code": "C5275", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2414.45, "discounted_cash": 564.0, "minimum": 372.86, "maximum": 2366.161, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 391.5 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 384.05 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 564.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 564.06, "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": 902.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 372.86 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 564.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 380.32 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 580.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 580.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 817.89, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 603.54, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 592.26, "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": 789.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 564.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 564.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 817.89, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 372.86 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 564.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 844.4, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 676.87, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 384.05 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 620.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 835.94, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1973.35 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 819.07, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 372.86 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 564.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 564.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 564.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 391.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 552.78, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 564.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 603.54, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 843.27, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "2.4MM VA -LCP VOLAR DISTAL RAD", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "187-02-69 Zimmer Steinmann Pin", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "14.3.3 ETA RHEUMATOID ARTHRITI", "code_information": [ { "code": "83520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 140.0, "discounted_cash": 17.0, "minimum": 7.5514, "maximum": 820.064, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 17.28, "10th_percentile": 17.28, "90th_percentile": 25.72, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "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": 27.63, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.04, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 129.08, "10th_percentile": 129.08, "90th_percentile": 129.08, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.48, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 18.13, "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": 24.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 59.56, "10th_percentile": 59.56, "90th_percentile": 185.76, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 25.04, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.85, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 19.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.59, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.08, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 82.08, "10th_percentile": 82.08, "90th_percentile": 82.08, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.92, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.48, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.54 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.82, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "2.5MM STANDARD DRILL", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "1ST 100 SQ CM FEET", "code_information": [ { "code": "C5277", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2414.45, "discounted_cash": 564.0, "minimum": 372.86, "maximum": 2366.161, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 391.5 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 384.05 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 564.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 564.06, "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": 902.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 372.86 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 564.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 380.32 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 580.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 580.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 817.89, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 603.54, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 592.26, "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": 789.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 564.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 564.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 817.89, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 372.86 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 564.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 844.4, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 676.87, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 384.05 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 620.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 835.94, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1973.35 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 819.07, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 372.86 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 564.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 564.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 564.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 391.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 552.78, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 564.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 603.54, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 843.27, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "17-HYDROXY PROGESTERONE", "code_information": [ { "code": "83498", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 50.0, "discounted_cash": 27.0, "minimum": 7.2, "maximum": 49.0, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.04 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 5.76, "10th_percentile": 5.76, "90th_percentile": 7.2, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.45 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 43.47, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.56 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.15 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 29.07, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 29.56 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 40.67, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 32.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.45 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 29.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 40.27, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 29.56 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 39.45, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.56 }, { "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 Duals", "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": 31.04 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.63, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.45 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.62, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "2.5 LOCKING SCRW #FP08-FP20", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 194.46, "10th_percentile": 194.46, "90th_percentile": 194.46, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 232.43, "10th_percentile": 232.43, "90th_percentile": 232.43, "count": "1 through 10" } ] } ] }, { "description": "2.5X12 MDS SCREW#131211112-116", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 194.46, "10th_percentile": 194.46, "90th_percentile": 194.46, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 232.43, "10th_percentile": 232.43, "90th_percentile": 232.43, "count": "1 through 10" } ] } ] }, { "description": "1ST 100 SQ CM LEGS", "code_information": [ { "code": "C5273", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7744.8, "discounted_cash": 1685.0, "minimum": 372.86, "maximum": 7589.904, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 391.5 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 384.05 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1685.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 1685.6, "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": 2696.96, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 372.86 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1685.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 380.32 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 1736.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 1736.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2444.12, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1803.59, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 1769.88, "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": 2359.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1685.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1685.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2444.12, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 372.86 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1685.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2523.34, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2022.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 384.05 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1854.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2498.06, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1973.35 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2447.66, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 372.86 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1685.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1685.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 1685.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 391.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1651.89, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1685.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1803.59, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2519.97, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "2.8MM GUIDE WIRE 300MM", "code_information": [ { "code": "C1769", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 904.16, "10th_percentile": 904.16, "90th_percentile": 904.16, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 3242.16, "10th_percentile": 3242.16, "90th_percentile": 3242.16, "count": "1 through 10" } ] } ] }, { "description": "2.7 VA LOCKING SCREW 16MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "1ST 100SQCM HEAD, FEET, HANDS", "code_information": [ { "code": "15277", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7744.8, "discounted_cash": 1942.0, "minimum": 372.86, "maximum": 7744.8, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 391.5 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 384.05 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1942.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 1942.46, "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": 3107.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 372.86 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1942.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 380.32 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 2000.73, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 2000.73, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2816.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2078.43, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 2039.58, "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": 2719.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1942.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1942.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2816.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 372.86 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1942.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2907.86, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2330.95, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 384.05 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2136.71, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2878.73, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1973.35 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2820.65, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 372.86 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1942.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1942.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 1942.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 391.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.61, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1942.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2078.43, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2903.98, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "25SQCM OR LESS HEAD, FEET", "code_information": [ { "code": "15276", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 214.94, "minimum": 64.482, "maximum": 214.94, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 214.94 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 214.94 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 214.94 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 214.94 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 214.94 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 214.94 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 214.94 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 214.94 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 214.94 } ] } ] }, { "description": "2.7 VA LOCKING SCREW 22MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "270143 Screw BN 4mm 6mm 40mm 2", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "2.7/3.5 VA EXT MEDL DHP 1 HOLE", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "2-STEP PPD", "code_information": [ { "code": "86580", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 85.85, "discounted_cash": 27.0, "minimum": 25.755, "maximum": 84.133, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.56 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.94 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 43.57, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.63 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 29.14, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 31.01 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 40.76, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 32.68, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.94 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 29.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 40.35, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 39.54, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "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 Duals", "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": 32.56 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.69, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.71, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "2.0MM THREADED GUIDE WIRE 230M", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "3.2MM DRILL BIT 145MM QUICK CO", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "2.7MM CORT.SCREW,202.8XX", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "2.3 MPROFYLE HAND LOCK L PLATE", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "2.2 GUIDEWIRES", "code_information": [ { "code": "C1769", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 904.16, "10th_percentile": 904.16, "90th_percentile": 904.16, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 3242.16, "10th_percentile": 3242.16, "90th_percentile": 3242.16, "count": "1 through 10" } ] } ] }, { "description": "3.2MM STANDARD DRILL TIP GUIDE", "code_information": [ { "code": "C1769", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 904.16, "10th_percentile": 904.16, "90th_percentile": 904.16, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 3242.16, "10th_percentile": 3242.16, "90th_percentile": 3242.16, "count": "1 through 10" } ] } ] }, { "description": "2.7mm Cortex screw slf-tpng T8", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "2.3 X 12MM BONE", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "2.4MM CORTEX SELF-TAPPING SCRE", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "3.5 LCP POSOMED PROX TIBIA PL", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "2.7mm LCP T-Plate 2 Holes He", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "2.3X13MM LOCKING SCREWSCROSSPI", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "2.5 NON LCK SRW SP 12000-20000", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 194.46, "10th_percentile": 194.46, "90th_percentile": 194.46, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 232.43, "10th_percentile": 232.43, "90th_percentile": 232.43, "count": "1 through 10" } ] } ] }, { "description": "3.5 LOCK SCREW S-T SD REC 30MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "20 ML DBX BONE PUTTY", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "2.4 CORTICAL SCREW #201.641", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 194.46, "10th_percentile": 194.46, "90th_percentile": 194.46, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 232.43, "10th_percentile": 232.43, "90th_percentile": 232.43, "count": "1 through 10" } ] } ] }, { "description": "2.5 THREADED GUIDE WIRE SPADE", "code_information": [ { "code": "C1769", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 904.16, "10th_percentile": 904.16, "90th_percentile": 904.16, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 3242.16, "10th_percentile": 3242.16, "90th_percentile": 3242.16, "count": "1 through 10" } ] } ] }, { "description": "3.5 LOCK SCREW S-T SD REC 36MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "24 HR. URINE ALDOSTERONE", "code_information": [ { "code": "82088", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 50.0, "discounted_cash": 40.0, "minimum": 3.0456, "maximum": 184.8966, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.06 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 9.06, "10th_percentile": 9.06, "90th_percentile": 9.06, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.32 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 50.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.2 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.94 }, { "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 Duals - My Care", "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": 50.0, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 43.6, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": 50.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 50.0, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.2 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 50.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 48.9, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.32 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 44.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 50.0, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 37.2 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 50.0, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.2 }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 21.02, "10th_percentile": 21.02, "90th_percentile": 36.48, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.06 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.94, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.68 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50.0, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "2.7 METAPHYSEA SCREW 30MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "3.5 LONG SYNTHES SCREW 3.5X65M - C1713 - 2782175", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "270139 Screw BN 4mm 6mm 32mm 2", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "2.5 WEB LOCKING PLT #151220255", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 194.46, "10th_percentile": 194.46, "90th_percentile": 194.46, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 232.43, "10th_percentile": 232.43, "90th_percentile": 232.43, "count": "1 through 10" } ] } ] }, { "description": "2.7/3.5 VA POSTLAP DHP 3 HOLE", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "3.5 VA PROX TIB PL SMALL BEND/", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "270148 Screw BN 4mm 6mm 70mm S", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "2.5MM DRIL TIP GUIDEWIRE 200MM", "code_information": [ { "code": "C1769", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 904.16, "10th_percentile": 904.16, "90th_percentile": 904.16, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 3242.16, "10th_percentile": 3242.16, "90th_percentile": 3242.16, "count": "1 through 10" } ] } ] }, { "description": "2347 SERIES 4.5MM CORT. SCREW", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "3.5MM CORTEX SCREW 3.5 X 40MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "3.0MMX12MM NONLOCK HEXALOBE", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "249.906 6 HOLE STRAIGHT PLATE", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 194.46, "10th_percentile": 194.46, "90th_percentile": 194.46, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 232.43, "10th_percentile": 232.43, "90th_percentile": 232.43, "count": "1 through 10" } ] } ] }, { "description": "3.5MM CORTEX SCREW 3.5 X 85MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "3.2 GUIDE WIRE", "code_information": [ { "code": "C1769", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 904.16, "10th_percentile": 904.16, "90th_percentile": 904.16, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 3242.16, "10th_percentile": 3242.16, "90th_percentile": 3242.16, "count": "1 through 10" } ] } ] }, { "description": "2.7 VA LOCKING SCREW 12MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "3% NACL", "drug_information": { "unit": 500.0, "type": "ML" }, "code_information": [ { "code": "00338005403", "type": "NDC" }, { "code": "J7040", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 42.26, "10th_percentile": 42.25, "90th_percentile": 42.26, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 51.06, "10th_percentile": 51.06, "90th_percentile": 51.06, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 47.63, "10th_percentile": 47.63, "90th_percentile": 47.63, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 47.63, "10th_percentile": 47.63, "90th_percentile": 47.63, "count": "13" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 50.51, "10th_percentile": 50.51, "90th_percentile": 101.01, "count": "18" } ] } ] }, { "description": "3.5MM CORTEX TI SCREW ?3.5MM/L - C1713 - 2783541", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "3.5 LCP PROX. TIB. PLATE 14 HO", "code_information": [ { "code": "C1716", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 511.0, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 1608.39, "10th_percentile": 1608.39, "90th_percentile": 1608.39, "count": "1 through 10" } ] } ] }, { "description": "2.7mm Locking screw slf-tpng T", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "3.0MM GUIDE FEMORALNAIL", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "3.5MM CORTEX TI SCREW ?3.5MM/L - C1713 - 2783542", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "3.5 LOCK SCREW S-T SD REC 42MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "2.8MM Q-FIX ALL SUTURE ANCHOR", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "3.5MM SCREWS,212.XX SERIES", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "3.5 LOCKING SCREW", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "3.2MM GUIDE WIRE 400MM", "code_information": [ { "code": "C1769", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 904.16, "10th_percentile": 904.16, "90th_percentile": 904.16, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 3242.16, "10th_percentile": 3242.16, "90th_percentile": 3242.16, "count": "1 through 10" } ] } ] }, { "description": "3.5MMX14MM NONLOCK HEXALOBE", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "3.5 LOCKING SCREW 16MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "24 HR. URINE FOR QUAN. GLUCOSE", "code_information": [ { "code": "82947", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14.52, "discounted_cash": 3.0, "minimum": 2.0909, "maximum": 122.5, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.52 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.52 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "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": 6.29, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.52 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.52 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 4.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 4.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.21, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 4.13, "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": 5.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.52 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5.88, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.52 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 4.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 14.52 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5.71, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.52 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.52 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.85, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.21, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.54 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.88, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "3.5 CORTICAL SCREW,#204.8XX SE", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "3D RENDER W/INTRP POSTPROCESS - 76376 - 3504002", "code_information": [ { "code": "76376", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1260.0, "minimum": 10.09, "maximum": 1234.8, "payers_information": [ { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 116.63 }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.09 } ] } ] }, { "description": "3.5 VA LCKNG SCR SLF-TPNG/SD/6", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "270141 Screw BN 4mm 6mm 36mmSS", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "3.5 CRTX FULL THRD 75MM SCREW", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "3D RENDERING - 76376 - 3204001", "code_information": [ { "code": "76376", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1077.0, "minimum": 10.09, "maximum": 1234.8, "payers_information": [ { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 116.63 }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.09 } ] } ] }, { "description": "3.5MM CORTEX SCREW 22MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "3.5 LCP RECONSTRUC PLATE 7H/98", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "3D RENDERING - 76376 - 6104001", "code_information": [ { "code": "76376", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1077.0, "minimum": 10.09, "maximum": 1234.8, "payers_information": [ { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 116.63 }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.09 } ] } ] }, { "description": "3.5MM CORTEX TI SCREW ?3.5MM/L - C1713 - 2783540", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "3.0MM REAMING ROD 351.71S disp", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "3.5 LOCKING SCREW RECESS 75MM", "code_information": [ { "code": "C1716", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 511.0, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 1608.39, "10th_percentile": 1608.39, "90th_percentile": 1608.39, "count": "1 through 10" } ] } ] }, { "description": "4.0 MM HEADED SCREW LENGTH 42M", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "3.5mm LCP T-Plate Right 3 Head", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "3.5 LONG SYNTHES SCREW 3.5X90M - C1713 - 2782176", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "3.5 LONG SYNTHES SCREW 3.5X65M - C1713 - 2782177", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "4.0MM CORTEX SCREW S-T 20MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "3.5MM VA LCP TIBIA PLATE 4-HOL", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "3.5 NONLOCKING SCREW", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "3.5 LONG SYNTHES SCREW 3.5X90M - C1713 - 2782178", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "4.0MM CORTEX SCREW S-T 36MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "3.7MM STANDARD DRILL", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "3.5 VA LCKNG SCR SLF-TPNG/SD/7", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "3.5MM CORTEX SCREW 24MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "4.0MM CORTEX SCREW S-T 60MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "3D RENDER W/INTRP POSTPROCESS - 76377 - 3204002", "code_information": [ { "code": "76377", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1260.0, "minimum": 26.09, "maximum": 1234.8, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 122.46 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 120.13 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 116.63 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 118.96 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 116.63 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 120.13 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 116.63 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 116.63 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 122.46 }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.09 } ] } ] }, { "description": "3.5MM CORTEX SCREW 20MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], 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"outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "4.0X48MM TI CANNULATED SCREW", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "4.5MM CORTEX SCREW ALL SIZES", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "3.5MM CORTEX SCREW SELF TAPPIN - C1713 - 2784464", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "3.5mm CORTEX TI SCREW ?3.5MM/L - C1713 - 2783539", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "4.0X50MM TI CANNULATED SCREW", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "4.5MM CORTEX TI SCREW ?4.5MM/L - C1713 - 2783172", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "3.5MM CORTEX SCREW SELF TAPPIN - C1713 - 2784465", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "3.5MM CORTICAL SCREW, SELF TAP - C1713 - 2782011", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "4.0X55MM TI CANNULATED SCREW", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "4.5MM CORTEX TI SCREW ?4.5MM/L - C1713 - 2783175", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "3.5MM CORTEX TI SCREW ?3.5MM/L - C1713 - 2782308", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "3.5MM LOCK SCRW SELF-TA ALL SZ", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "4.5M CORTEX TI SCREWV?4.5MM /L", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "4.5MM CORTEX TI SCREW 4.5MMX50", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "3.5MM CORTICAL SCREW, SELF TAP - C1713 - 2782012", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "3.5MMX10MM NONLOCK HEXALOBE", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "4.5MM CORTEX TI SCREW ?4.5MM/L - C1713 - 2783174", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "4.5MM CORTEX TI SCREW 4.5X38MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "3.5MMX12MM NONLOCK HEXALOBE", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "3.5MMX8MM NONLOCK HEXALOBE", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "4.5MM VA LCP CURVED PLATE 16 H", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "4.5MM CORTEX TI SCREW 4.5X44MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "3D RENDER W/INTRP POSTPROCESS - 76376 - 6104002", "code_information": [ { "code": "76376", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1260.0, "minimum": 10.09, "maximum": 1234.8, "payers_information": [ { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 116.63 }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.09 } ] } ] }, { "description": "3DMAX LIGHT MESH LARGE", "code_information": [ { "code": "C1781", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 2101.84, "10th_percentile": 1744.87, "90th_percentile": 5455.45, "count": "1 through 10" } ] } ] }, { "description": "4.5MM VA LCP CURVED PLATE 8 HO", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "4.5MM CORTEX TI SCREW 4.5X60MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "3D RENDERING - 76376 - 3504001", "code_information": [ { "code": "76376", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1077.0, "minimum": 10.09, "maximum": 1234.8, "payers_information": [ { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 116.63 }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.09 } ] } ] }, { "description": "4.0 MM HEADED SCREW LENGTH 38M", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "5.0 Cannu. Locking Screw 50mm", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "4.5MM VA LCP CURVED PLATE 6 HO", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "4 HOLE PROXIMAL TIBIAL PLATE", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "4.0 X42MM TI CANNULATED SCREW", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "5.0 SLF DRLL SCHANZ SCR 60/150", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "4.5mm VA-LCP curved condylarpl", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "4.0 CANNULATED SCREW 4.0X20MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "4.0MM CORTEX SCREW S-T 48MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "5.0 SLFDRILL SCREW 80 THRD/250", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "4.8 CANNULATED REAMER", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "4.0 X34MM TI CANNULATED SCREW", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "4.0MM CORTEX SCREW S-T 56MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "5.0MM ANGULAR STABLE LOCKING S - C1713 - 2781119", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "4MM LOCKING SCREW 4.0 X 65MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "4.0MM CORTEX SCREW S-T 30MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "4.0X30MM TI CANNULATED SCREW", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "5.0MM TI LOCKING SCREW 36MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "4MM LOCKING SCREW 4.0 X 80MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "4.0MM CORTEX SCREW S-T 40MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "4.0X36mm TI CANNULATED SCREW", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "5.0mm x 70mm Cannulated VA loc", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "5' NUCLEOTIDASE LC", "code_information": [ { "code": "83915", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 55.75, "discounted_cash": 11.0, "minimum": 8.028, "maximum": 54.635, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.6 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.11 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "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": 17.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.87 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 11.48, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 11.48, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.17, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.93, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 11.71, "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": 15.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 47.95, "10th_percentile": 47.95, "90th_percentile": 47.95, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.17, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.69, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 13.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.11 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 12.27, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.52, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.19, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.93, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.93, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.04 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "4.0MM CORTEX SCREW S-T 70MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "4.5MM CORTEX SCW SELF-TAPPING", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "510443 ONCOLOGY CHG2", "code_information": [ { "code": "88271", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 146.08, "discounted_cash": 21.0, "minimum": 12.6014, "maximum": 2572.9704, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "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": 34.27, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 22.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 22.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.06, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 22.92, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 22.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 29.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 31.06, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 32.07, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 25.7, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 23.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.74, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 112.76 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.1, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.99, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22.92, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.28 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.02, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "5.0 TI LOCKING SCREW 38MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "4.0X24MM TI CANNULATED SCREW", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "4.5MM CORTEX TI SCREW ?4.5MM/L - C1713 - 2782309", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "5MM LCOKING SCREW 5.0MM/L44", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "5.0 TI SCHANZ SCREWS", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "4.3MM DRILL BIT 180MM QUICK CO", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "4.5MM CORTEX TI SCREW 4.5MMX48", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "5MM LOCKING SCREW 5.0MM/L22MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "5.0MM CANU VA LCKNG SCREW 85MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "4.5 VA-LCP CURVED COND PLATE 1", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "4.5MM VA-LCP CUR COND PLATE 16 - C1713 - 2781201", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "5MM LOCKING SCREW 5.0MM/L70MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "5.0MM VA LK SF-TNG SCRW ALL SZ - C1713 - 2782047", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "4.5MM CORT SLF-TPG SCRW ALL SZ", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "4.5mm x 36mm Cortex screw self - C1713 - 2785610", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "5MM LOCKING SCREW 5.0MM/L80MM - C1713 - 2784119", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "5X180 APEX S/D HALF PIN 50 THR", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "4.5MM CORTEX TI SCREW ?4.5MM/L - C1713 - 2782311", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "4.5mm x 36mm Cortex screw self - C1713 - 2785611", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "5MM LOCKING SCREW 5.0MM/L85MM - C1713 - 2783171", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "6.5 CANC BONE SCREW F-T 85MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "4.5MM CORTEX TI SCREW ?4.5MM/L - C1713 - 2783173", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "4MM LOCKING SCREW 4.0 X 75MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "6.5MM LOW PROFILE HEX SCREW 25 - C1713 - 2784241", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "6.5 CANC BONE SCREW F-T 95MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "4.5MM CORTEX TI SCREW ?4.5MM/L - C1713 - 2783176", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "5-HIAA", "code_information": [ { "code": "83497", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40.75, "discounted_cash": 12.0, "minimum": 5.868, "maximum": 39.935, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.04 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.45 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 20.64, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.56 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.15 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.8, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 29.56 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.48, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.45 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.12, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 29.56 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.73, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.56 }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 37.16, "10th_percentile": 37.16, "90th_percentile": 37.16, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 31.04 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.64, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.61 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.29, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "6.5MM LOW PROFILE HEX SCREW 25 - C1713 - 2785202", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "6.5 x80mm TI CANNULATED SCREW", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "4.5MM CORTEX TI SCREW 4.5X36MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "5.0 Cann. Locking Screw 35mm", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "7.3 CANN SCREW F-T 65MM - C1713 - 2781262", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "6.5MM LOW PROFILE HEX SCREW 25 - C1713 - 2784219", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "4.5MM CORTEX TI SCREW 4.5X42MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "5.0 LOCKING SCREWS", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "7.3 CANNULATED SCREW 16MM/105M", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "6.5MM LOW PROFILE HEX SCREW 30", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "4.5MM THREADED POSITIONING PIN", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "5.0 SLF DRLL SCHANZ SCR 60/200", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "7.3MM CANNULATED SCREWS 80MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "7.3 CANN SCREW F-T 50MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "4.5MM VA-LCP CUR COND PLATE 16 - C1713 - 2782046", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "5.0 X 32.5 MM TITANIUM SCREW", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "7.3MM CANNULATED SCREWS 85MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "7.3 CANNULATED SCREW 16MM THRE - C1713 - 2782173", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "4MM LOCKING SCREW 4.0 X 70MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "5.0 X 35 MM TITANIUM SCREW", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "733727 10+Oxycodone+Crt-Scr", "code_information": [ { "code": "80307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 222.4, "discounted_cash": 62.0, "minimum": 2.9664, "maximum": 1127.0, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 22.95, "10th_percentile": 22.94, "90th_percentile": 63.85, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 99.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": 90.1, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 146.9, "10th_percentile": 146.9, "90th_percentile": 146.9, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 66.49, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": 87.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 144.0, "10th_percentile": 134.94, "90th_percentile": 144.0, "count": "14" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 137.02, "10th_percentile": 63.73, "90th_percentile": 137.02, "count": "15" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 90.1, "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 93.02, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 74.57, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 68.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 92.09, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 46.78 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 90.23, "additional_payer_notes": "145.21% 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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 145.31, "10th_percentile": 145.31, "90th_percentile": 145.31, "count": "27" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.9, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.93 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 92.9, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "7.3 CANNULATED SCREW 16MM/100M", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "5 HOLE TUBULAR PLATE", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "5.0MM ANGULAR STABLE LOCKING S - C1713 - 2781117", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "8.0 X 70MM TI CANNULATED SCREW", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "A. FUMIGATUS #1 AB", "code_information": [ { "code": "86671", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26.41, "discounted_cash": 12.0, "minimum": 2.88, "maximum": 122.5, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 3.81, "10th_percentile": 3.81, "90th_percentile": 3.81, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "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": 19.6, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.62, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 12.62, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.76, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.11, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 12.86, "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": 17.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.76, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.34, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.15, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 26.41 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.11, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.03 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.31, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "5.0MM LOCKING SCREW 36MM F/IM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "9 HOLE LAT TIB PLATE", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "A. PULLULANS ABS", "code_information": [ { "code": "86606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 32.44, "discounted_cash": 15.0, "minimum": 4.6714, "maximum": 85.6912, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 4.68, "10th_percentile": 4.68, "90th_percentile": 4.68, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 24.08, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 21.82, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 22.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 16.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 22.3, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.85, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "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": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.5, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "5.0MM LOCKING SCREW 28MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "5.0MM VA LOCKING SCRW ALL SIZE", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "A PHAGOCYTOPHILUM PCR", "code_information": [ { "code": "87798", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 143.4, "discounted_cash": 35.0, "minimum": 4.6512, "maximum": 646.8, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 34.32, "10th_percentile": 4.65, "90th_percentile": 48.6, "count": "16" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 56.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.55, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 183.27, "10th_percentile": 183.27, "90th_percentile": 191.25, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 26.87, "10th_percentile": 26.87, "90th_percentile": 290.25, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 42.11, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 38.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.0, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 45.17 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 50.95, "additional_payer_notes": "145.21% 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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 114.0, "10th_percentile": 29.46, "90th_percentile": 307.8, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 34.39, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.58 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.46, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "A2 HEMOGLOBIN", "code_information": [ { "code": "83021", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 36.64, "discounted_cash": 18.0, "minimum": 4.5072, "maximum": 44.884, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 28.9, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.41 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.64 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 11.41 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 21.67, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 19.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.76, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 11.41 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.22, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.41 }, { "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 Duals", "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": 11.98 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.7, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.25 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.0, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "5.0MM LOCKING SCREW 40MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "5.0mm x 32mm VA Locking self t", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "ABDOMEN-FLAT AND UPRIGHT - 74021 - 3220001", "code_information": [ { "code": "74021", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 787.57, "discounted_cash": 98.0, "minimum": 19.44, "maximum": 771.8186, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "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": 157.47, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 101.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 101.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 142.71, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 105.31, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 103.34, "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": 137.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 142.71, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 147.33, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 118.1, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 108.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 145.86, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 142.92, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.45, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 105.31, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.44 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 147.14, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ABDOMEN-FLAT AND UPRIGHT - 74019 - 3240001", "code_information": [ { "code": "74019", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 787.57, "discounted_cash": 98.0, "minimum": 16.49, "maximum": 771.8186, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 80.09 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 600.92, "10th_percentile": 600.92, "90th_percentile": 600.92, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.57 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "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": 157.47, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.81 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 101.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 101.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 142.71, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 105.31, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 103.34, "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": 137.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 236.27, "10th_percentile": 236.27, "90th_percentile": 236.27, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 142.71, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 147.33, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 118.1, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.57 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 108.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 145.86, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 142.92, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 718.26, "10th_percentile": 718.26, "90th_percentile": 718.26, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 80.09 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.45, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 105.31, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.49 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 147.14, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "5.0MM VA LK SF-TNG SCRW ALL SZ - C1713 - 2781202", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "5MM LCOKING SCREW 5.0MM/L70MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "ABDOMINAL PAIN - SOI : 1", "code_information": [ { "code": "2511", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4498.087, "maximum": 4812.95, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 4722.99 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4633.03 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4498.09 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 4678.01 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4498.09 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 4633.03 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4498.09 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 4498.09 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4812.95 } ] } ] }, { "description": "ABDOMEN-UPRIGHT (1 V)", "code_information": [ { "code": "74018", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 475.0, "discounted_cash": 81.0, "minimum": 13.78, "maximum": 465.5, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 362.43, "10th_percentile": 362.43, "90th_percentile": 362.43, "count": "30" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "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": 131.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 84.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 84.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 118.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 437.95, "10th_percentile": 437.95, "90th_percentile": 437.95, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 87.67, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 86.03, "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": 114.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 142.5, "10th_percentile": 142.5, "90th_percentile": 142.5, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 408.5, "10th_percentile": 408.5, "90th_percentile": 408.5, "count": "11" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 118.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 122.65, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 98.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 90.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 121.42, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 118.97, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 433.2, "10th_percentile": 433.2, "90th_percentile": 433.2, "count": "17" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80.29, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 87.67, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.78 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 122.49, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "5.0mm x 34mm VA Locking self t", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "5MM LOCKING SCREW 5.0MM/L44", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "ABDOMINAL PAIN - SOI : 4", "code_information": [ { "code": "2514", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7984.052, "maximum": 8542.94, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 8383.25 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 8223.57 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7984.05 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 8303.41 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7984.05 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 8223.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7984.05 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 7984.05 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8542.94 } ] } ] }, { "description": "ABDOMINAL PAIN - SOI : 3", "code_information": [ { "code": "2513", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7984.052, "maximum": 8542.94, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 8383.25 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 8223.57 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7984.05 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 8303.41 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7984.05 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 8223.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7984.05 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 7984.05 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8542.94 } ] } ] }, { "description": "5.0mm x 80mm Cannulated VA loc", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "5MM LOCKING SCREW 5.0MM/L80MM - C1713 - 2783170", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY", "code_information": [ { "code": "770", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8421.0, "minimum": 2940.0, "maximum": 13473.856, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7610.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 7610.07, "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": 13473.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7610.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 7838.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 7838.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 12210.68, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8142.77, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 8842.22, "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": 10947.51, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7838.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 7610.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12210.68, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7610.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10198.02, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 10105.39, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 13473.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 8371.08, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10096.13, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9892.34, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8421.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8345.19 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 7610.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 12133.67 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 7610.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7457.87, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 8421.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 9010.64, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4178.66 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10198.02, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ABG DRAW - 36600 - 4500010", "code_information": [ { "code": "36600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 532.4, "discounted_cash": 125.0, "minimum": 47.9881, "maximum": 521.752, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 200.4, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 134.02, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 150.3, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 137.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 185.62, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 47.99 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 181.88, "additional_payer_notes": "145.21% 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 Duals", "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": 122.75, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 187.25, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "5MM LOCKING SCREW 5.0MMX24MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "5MM LOCKING SCREW 5.0MM/L85MM - C1713 - 2784120", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "ABORTION WO D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY - SOI : 2", "code_information": [ { "code": "5642", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3919.94, "maximum": 4194.34, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 4115.94 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4037.54 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3919.94 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 4076.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3919.94 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 4037.54 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3919.94 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 3919.94 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4194.34 } ] } ] }, { "description": "ABO", "code_information": [ { "code": "86900", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 279.7, "discounted_cash": 125.0, "minimum": 2.69, "maximum": 274.106, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.28 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 40.28, "10th_percentile": 40.28, "90th_percentile": 40.28, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.53 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 200.4, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.41 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.16 }, { "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 Duals - My Care", "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": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 515.77, "10th_percentile": 515.77, "90th_percentile": 515.77, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 134.02, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 37.41 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 150.3, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.53 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 137.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 185.62, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 37.41 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 181.88, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.41 }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 255.09, "10th_percentile": 255.09, "90th_percentile": 255.09, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 39.28 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 122.75, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.69 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 187.25, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "5MM LOCKING SCREW 5.0MMX85MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "5X150 APEX S/D HALF PIN 50THR", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY- SOI : 2", "code_information": [ { "code": "5432", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4709.385, "maximum": 5039.04, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 4944.85 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4850.67 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4709.39 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 4897.76 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4709.39 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 4850.67 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4709.39 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 4709.39 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5039.04 } ] } ] }, { "description": "6.5 x75mm TI CANNULATED SCREW", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "6.0MM TITANIUM LOCKING SCREW,", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "ABORTION WITHOUT D&C", "code_information": [ { "code": "779", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7155.0, "minimum": 2706.31, "maximum": 11449.04, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6475.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 6475.12, "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": 11449.04, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6475.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 6669.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 6669.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 10375.69, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6928.38, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 7513.43, "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": 9302.35, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6669.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 6475.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10375.69, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 6475.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8665.49, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 8586.78, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 11449.04, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 7122.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8578.91, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8405.74, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7155.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4484.46 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 6475.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 10180.57 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 6475.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6345.62, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 7155.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 7656.55, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 2706.31 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8665.49, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "7.3 CANNULATED SCREW 16MM THRE - C1713 - 2782172", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "6.5 LOW PROFILE HEX SCREW 30MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "ABORTION WO D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY - SOI : 3", "code_information": [ { "code": "5643", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7732.293, "maximum": 8273.55, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 8118.91 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7964.26 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7732.29 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 8041.58 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7732.29 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 7964.26 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7732.29 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 7732.29 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8273.55 } ] } ] }, { "description": "7.3 CANNULATED SCREW 16MM/90MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "6.5mm fully threaded screws", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "ABDOMINAL PAIN - SOI : 2", "code_information": [ { "code": "2512", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5616.617, "maximum": 6009.78, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 5897.45 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5785.12 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5616.62 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 5841.28 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5616.62 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 5785.12 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5616.62 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 5616.62 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6009.78 } ] } ] }, { "description": "ACTH,PLASMA", "code_information": [ { "code": "82024", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28.75, "discounted_cash": 38.0, "minimum": 4.14, "maximum": 28.75, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.75 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 4.14, "10th_percentile": 3.31, "90th_percentile": 4.14, "count": "12" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.75 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 28.75, "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": 28.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.75 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.75 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 28.75, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 28.75, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.75, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 28.75, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 28.75, "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": 28.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 24.73, "10th_percentile": 24.73, "90th_percentile": 24.73, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 19.78, "10th_percentile": 19.78, "90th_percentile": 24.73, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 28.75, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.75 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 28.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 28.75, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.75 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 28.75, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 28.75, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 28.75 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 28.75, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 26.22, "10th_percentile": 20.98, "90th_percentile": 26.22, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 28.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.75 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.75, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 28.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 28.75, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.75 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.75, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ACCOLADE II SIZE 4 127 DEGREES", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 9453.57, "10th_percentile": 9453.57, "90th_percentile": 9453.57, "count": "1 through 10" } ] } ] }, { "description": "ABG DRAW - 36600 - 3008961", "code_information": [ { "code": "36600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 532.4, "discounted_cash": 125.0, "minimum": 47.9881, "maximum": 521.752, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 200.4, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 134.02, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 150.3, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 137.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 185.62, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 47.99 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 181.88, "additional_payer_notes": "145.21% 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 Duals", "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": 122.75, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 187.25, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "7-HOLE PLATE LAT FIB", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "ACTIVATED PROTEIN C RESISTANCE", "code_information": [ { "code": "85307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 146.6, "discounted_cash": 15.0, "minimum": 11.4069, "maximum": 143.668, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 21.11, "10th_percentile": 21.11, "90th_percentile": 21.12, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 24.51, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.41 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.64 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.39, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 11.41 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 22.93, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 22.7, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 11.41 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 22.25, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.41 }, { "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 Duals", "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": 11.98 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.01, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.9, "additional_payer_notes": "149.50% 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": 3594.451, "maximum": 3846.06, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 3774.17 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3702.28 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3594.45 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 3738.23 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3594.45 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 3702.28 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3594.45 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 3594.45 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3846.06 } ] } ] }, { "description": "7.3 CANN SCREW F-T 65MM - C1713 - 2781261", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "ACUMED 3.5X12 LOCKING SCREW", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "ACETIBULAR SHELL 52MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY- SOI : 4", "code_information": [ { "code": "5434", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11148.126, "maximum": 11928.49, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 11705.53 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 11482.57 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 11148.13 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 11594.05 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 11148.13 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 11482.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11148.13 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 11148.13 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 11928.49 } ] } ] }, { "description": "7.3 CANNULATED SCREW 16MM THRE - C1713 - 2782174", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "ACUMED 3.5X16 LOCKING SCREW", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "ACETONE_ SERUM", "code_information": [ { "code": "82010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 130.85, "discounted_cash": 8.0, "minimum": 7.35, "maximum": 163.268, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.58 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.26 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 13.07, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.11 }, { "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 Duals - My Care", "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": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 120.64, "10th_percentile": 120.64, "90th_percentile": 120.64, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 15.79 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 12.23, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 9.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.26 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 8.99, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11.86, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 119.34, "10th_percentile": 119.34, "90th_percentile": 119.34, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 16.58 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.01, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.35 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.21, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ABORTION WO D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY - SOI : 1", "code_information": [ { "code": "5641", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3023.497, "maximum": 3235.14, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 3174.67 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3114.2 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3023.5 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 3144.44 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3023.5 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 3114.2 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3023.5 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 3023.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3235.14 } ] } ] }, { "description": "8.0 X 75MM TI CANNULATED SCREW", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "ACUMED HUB CAP POST #PL-WF50", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "ACHR BINDING ABS, SERUM", "code_information": [ { "code": "86041", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 57.0, "discounted_cash": 18.0, "minimum": 8.208, "maximum": 55.86, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.56 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.94 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 29.44, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.63 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.69, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 31.01 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.54, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.08, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.94 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.27, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.72, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "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 Duals", "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": 32.56 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.03, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.56 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.51, "additional_payer_notes": "149.50% 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": 7732.293, "maximum": 8273.55, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 8118.91 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7964.26 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7732.29 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 8041.58 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7732.29 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 7964.26 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7732.29 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 7732.29 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8273.55 } ] } ] }, { "description": "a-FETOPROTEIN WITH AFP-L3%", "code_information": [ { "code": "82107", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 375.0, "discounted_cash": 64.0, "minimum": 28.03, "maximum": 367.5, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.43 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.87 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 103.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.03 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.59 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 66.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 66.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 93.39, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 68.92, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 67.63, "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": 90.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 93.39, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.03 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 96.42, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 77.29, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.87 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 70.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 95.46, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 28.03 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 93.53, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.03 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63.12, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 68.92, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57.97 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 96.29, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ACUMED HUB CAP WRIST FUSON PLT", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "ACHR MODULATING ANTIBODIES", "code_information": [ { "code": "83519", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 260.64, "discounted_cash": 18.0, "minimum": 4.032, "maximum": 255.4272, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 6.57, "10th_percentile": 6.57, "90th_percentile": 6.57, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 29.44, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.69, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 26.68, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.54, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.08, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.27, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.72, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.03, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.56 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.51, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ABD PARACENTESIS W/IMAGING", "code_information": [ { "code": "49083", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4131.95, "discounted_cash": 853.0, "minimum": 836.7926, "maximum": 4049.311, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 1366.19, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 853.87, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 913.64, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 853.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 853.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1278.24, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1024.64, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 939.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1265.44, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2219.22 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1239.9, "additional_payer_notes": "145.21% 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 Duals", "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": 836.79, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1276.54, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ACUTE & SUBACUTE ENDOCARDITIS - SOI : 1", "code_information": [ { "code": "1931", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6968.024, "maximum": 7455.79, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 7316.43 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7177.06 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6968.02 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 7246.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6968.02 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 7177.06 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6968.02 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 6968.02 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7455.79 } ] } ] }, { "description": "AC JTS BILAT WO/W WEIGHTS - 73050 - 3220005", "code_information": [ { "code": "73050", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 467.92, "discounted_cash": 81.0, "minimum": 12.8, "maximum": 458.5616, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "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": 131.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 84.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 84.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 118.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 87.67, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 86.03, "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": 114.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 118.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 122.65, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 98.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 90.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 121.42, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 118.97, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80.29, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 87.67, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.8 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 122.49, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ABDOMEN (KUB) - 74018 - 3220000", "code_information": [ { "code": "74018", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 475.0, "discounted_cash": 81.0, "minimum": 13.78, "maximum": 465.5, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 80.09 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 362.43, "10th_percentile": 362.43, "90th_percentile": 362.43, "count": "30" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.57 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "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": 131.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.81 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 84.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 84.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 118.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 437.95, "10th_percentile": 437.95, "90th_percentile": 437.95, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 87.67, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 86.03, "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": 114.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 142.5, "10th_percentile": 142.5, "90th_percentile": 142.5, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 408.5, "10th_percentile": 408.5, "90th_percentile": 408.5, "count": "11" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 118.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 122.65, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 98.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.57 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 90.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 121.42, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 118.97, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 433.2, "10th_percentile": 433.2, "90th_percentile": 433.2, "count": "17" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 80.09 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80.29, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 87.67, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.78 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 122.49, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ACUTE ABDOMINAL SERIES - 74022 - 3240002", "code_information": [ { "code": "74022", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 632.86, "discounted_cash": 98.0, "minimum": 22.4, "maximum": 819.0742, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 637.71, "10th_percentile": 637.71, "90th_percentile": 637.71, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "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": 157.47, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 101.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 101.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 142.71, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 105.31, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 103.34, "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": 137.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 142.71, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 147.33, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 118.1, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 108.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 145.86, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 142.92, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.45, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 105.31, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.4 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 147.14, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ACUMED 2.0X5 QUIK REL DRIL BIT", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "AC JTS BILAT WO/W WEIGHTS - 73050 - 3240005", "code_information": [ { "code": "73050", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 452.93, "discounted_cash": 81.0, "minimum": 12.8, "maximum": 458.5616, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 80.09 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.57 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "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": 131.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.81 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 84.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 84.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 118.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 87.67, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 86.03, "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": 114.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 118.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 122.65, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 98.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.57 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 90.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 121.42, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 118.97, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 80.09 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80.29, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 87.67, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.8 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 122.49, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ABDOMEN (KUB) - 74018 - 3240000", "code_information": [ { "code": "74018", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 475.0, "discounted_cash": 81.0, "minimum": 13.78, "maximum": 465.5, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 362.43, "10th_percentile": 362.43, "90th_percentile": 362.43, "count": "30" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "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": 131.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 84.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 84.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 118.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 437.95, "10th_percentile": 437.95, "90th_percentile": 437.95, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 87.67, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 86.03, "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": 114.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 142.5, "10th_percentile": 142.5, "90th_percentile": 142.5, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 408.5, "10th_percentile": 408.5, "90th_percentile": 408.5, "count": "11" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 118.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 122.65, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 98.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 90.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 121.42, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 118.97, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 433.2, "10th_percentile": 433.2, "90th_percentile": 433.2, "count": "17" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80.29, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 87.67, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.78 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 122.49, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CCMCC", "code_information": [ { "code": "290", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7848.0, "minimum": 4595.5, "maximum": 15750.0, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7096.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 7096.74, "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": 12558.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7096.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 7309.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 7309.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 11380.73, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7593.51, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 8241.22, "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": 10203.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7309.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 7096.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11380.73, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7096.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9504.87, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 9418.54, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 12558.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 7806.41, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9409.9, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9219.96, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7848.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10624.1 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 7096.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 11250.3 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 7096.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6954.81, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 7848.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 8398.19, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4998.38 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9504.87, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ACUMED 2.7X10 CRUICIFORM SCREW", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "ABDOMEN (MIN 3 V)", "code_information": [ { "code": "74021", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 562.55, "discounted_cash": 98.0, "minimum": 19.44, "maximum": 771.8186, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 80.09 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.57 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "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": 157.47, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.81 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 101.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 101.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 142.71, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 105.31, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 103.34, "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": 137.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 142.71, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 147.33, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 118.1, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.57 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 108.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 145.86, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 142.92, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 80.09 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.45, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 105.31, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.44 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 147.14, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ACUTE BRONCHITIS AND RELATED SYMPTOMS - SOI : 4", "code_information": [ { "code": "1454", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14302.309, "maximum": 15303.47, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 15017.42 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 14731.38 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 14302.31 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 14874.4 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 14302.31 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 14731.38 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 14302.31 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 14302.31 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 15303.47 } ] } ] }, { "description": "ACUMED 2.7X12 CRUCIFORM SCREW", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "ACETAMINOPHEN", "code_information": [ { "code": "80329", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 287.97, "minimum": 23.616, "maximum": 282.2106, "payers_information": [ { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 40.47 } ] } ] }, { "description": "ABDOMEN (MIN 3V)", "code_information": [ { "code": "74021", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 562.55, "discounted_cash": 98.0, "minimum": 19.44, "maximum": 771.8186, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "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": 157.47, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 101.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 101.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 142.71, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 105.31, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 103.34, "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": 137.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 142.71, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 147.33, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 118.1, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 108.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 145.86, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 142.92, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.45, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 105.31, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.44 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 147.14, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA - SOI : 1", "code_information": [ { "code": "6901", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 25681.825, "maximum": 27479.55, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 26965.92 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 26452.28 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 25681.83 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 26709.1 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 25681.83 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 26452.28 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 25681.83 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 25681.83 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 27479.55 } ] } ] }, { "description": "ACUMED 3.5X14 NON LOCKING SCRW", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "ACHR - MODULATING", "code_information": [ { "code": "86043", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 325.8, "discounted_cash": 12.0, "minimum": 10.85, "maximum": 319.284, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.56 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.94 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 19.28, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.63 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.89, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 31.01 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.94 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.86, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.5, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "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 Duals", "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": 32.56 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.81, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.85 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.01, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ABO/RH TYPE", "code_information": [ { "code": "86900", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19.45, "discounted_cash": 125.0, "minimum": 2.69, "maximum": 274.106, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 40.28, "10th_percentile": 40.28, "90th_percentile": 40.28, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 19.45, "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": 19.45, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 19.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 19.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.45, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 515.77, "10th_percentile": 515.77, "90th_percentile": 515.77, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.45, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 19.45, "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": 19.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 19.45, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.45, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 19.45, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 19.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.45, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 19.45 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.45, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 255.09, "10th_percentile": 255.09, "90th_percentile": 255.09, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 19.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.45, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 19.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.45, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.69 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.45, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ACUTE MAJOR EYE INFECTIONS WITH CCMCC", "code_information": [ { "code": "121", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9680.0, "minimum": 4156.57, "maximum": 18450.0, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8739.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 8739.39, "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": 15488.64, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8739.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 9001.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 9001.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 14036.58, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9351.15, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 10164.42, "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": 12584.52, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9001.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 8739.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14036.58, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8739.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11722.96, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 11616.48, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 15488.64, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 9613.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11605.83, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11371.57, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9680.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4720.07 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 8739.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 14077.09 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 8739.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8564.6, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 9680.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 10358.03, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4156.57 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11722.96, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ACUMED:80-1524", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "Active Wound Care Management", "code_information": [ { "code": "97602", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 882.25, "discounted_cash": 188.0, "minimum": 185.1024, "maximum": 864.605, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 302.21, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.88, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 202.1, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 282.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 226.66, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 207.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 279.92, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 321.22 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 274.27, "additional_payer_notes": "145.21% 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 Duals", "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": 185.1, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 282.38, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY- SOI : 3", "code_information": [ { "code": "5433", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6047.305, "maximum": 6470.62, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 6349.67 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 6228.72 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6047.31 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 6289.2 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6047.31 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 6228.72 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6047.31 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 6047.31 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6470.62 } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION - SOI : 1", "code_information": [ { "code": "1901", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4937.766, "maximum": 5283.41, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 5184.65 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5085.9 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4937.77 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 5135.28 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4937.77 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 5085.9 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4937.77 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 4937.77 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5283.41 } ] } ] }, { "description": "ACUTE & SUBACUTE ENDOCARDITIS - SOI : 4", "code_information": [ { "code": "1934", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15463.099, "maximum": 16545.52, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 16236.25 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 15926.99 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 15463.1 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 16081.62 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 15463.1 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 15926.99 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15463.1 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 15463.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 16545.52 } ] } ] }, { "description": "ACUMED 2.7X14 CRUCIFORM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION - SOI : 3", "code_information": [ { "code": "1903", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7842.887, "maximum": 8391.89, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 8235.03 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 8078.17 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7842.89 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 8156.6 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7842.89 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 8078.17 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7842.89 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 7842.89 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8391.89 } ] } ] }, { "description": "ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION", "code_information": [ { "code": "880", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8087.0, "minimum": 2984.8, "maximum": 12940.688, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7311.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 7311.21, "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": 12940.69, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7311.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 7530.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 7530.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 11727.5, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7822.99, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 8492.33, "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": 10514.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7530.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 7311.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11727.5, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7311.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9794.48, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 9705.52, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 12940.69, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 8042.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9696.62, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9500.89, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8087.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6422.16 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 7311.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 11619.38 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 7311.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7164.99, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 8087.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 8654.09, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4217.79 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9794.48, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ACUMED 6HOLE L CLAVICLE PLATE", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "ACCOLADE HFx Size #4", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 9453.57, "10th_percentile": 9453.57, "90th_percentile": 9453.57, "count": "1 through 10" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION - SOI : 4", "code_information": [ { "code": "1904", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12464.467, "maximum": 13336.98, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 13087.69 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 12838.4 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 12464.47 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 12963.05 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 12464.47 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 12838.4 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12464.47 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 12464.47 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 13336.98 } ] } ] }, { "description": "ACUTE ANXIETY & DELIRIUM STATES - SOI : 3", "code_information": [ { "code": "7563", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10311.027, "maximum": 11032.8, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 10826.58 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 10620.36 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 10311.03 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 10723.47 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 10311.03 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 10620.36 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10311.03 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 10311.03 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 11032.8 } ] } ] }, { "description": "ACUMED:AT2-C14", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "ACHR BLOCKING ABS, SERUM", "code_information": [ { "code": "83519", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 120.0, "discounted_cash": 18.0, "minimum": 4.032, "maximum": 255.4272, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 6.57, "10th_percentile": 6.57, "90th_percentile": 6.57, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 29.44, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.69, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 26.68, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.54, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.08, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.27, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.72, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.03, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.56 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.51, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC", "code_information": [ { "code": "281", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7765.0, "minimum": 3151.2, "maximum": 12425.072, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7022.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 7022.2, "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": 12425.07, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7022.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 7232.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 7232.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 11260.22, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7513.75, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 8153.95, "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": 10095.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7232.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 10800.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4500.0, "10th_percentile": 4500.0, "90th_percentile": 4500.0, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 7022.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11260.22, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7022.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9404.23, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 9318.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 12425.07, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 7724.42, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9310.26, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9122.33, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7765.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10040.4 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 7022.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 11122.03 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 7022.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6881.76, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 7765.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 8309.27, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7634.27 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9404.23, "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": 5291.128, "maximum": 5661.51, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 5555.68 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5449.86 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5291.13 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 5502.77 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5291.13 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 5449.86 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5291.13 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 5291.13 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5661.51 } ] } ] }, { "description": "ACUTE & SUBACUTE ENDOCARDITIS - SOI : 3", "code_information": [ { "code": "1933", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9742.77, "maximum": 10424.76, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 10229.91 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 10035.05 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 9742.77 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 10132.48 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 9742.77 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 10035.05 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9742.77 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 9742.77 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10424.76 } ] } ] }, { "description": "ACYLCARNITINE PROFILE", "code_information": [ { "code": "82017", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 271.0, "discounted_cash": 16.0, "minimum": 15.18, "maximum": 265.58, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.6 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.11 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 26.99, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.87 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 24.38 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.11 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 18.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.0, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.5, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "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 Duals", "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": 25.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.53, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.18 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.22, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA - SOI : 4", "code_information": [ { "code": "6904", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 80596.801, "maximum": 86238.58, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 84626.64 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 83014.71 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 80596.8 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 83820.67 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 80596.8 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 83014.71 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 80596.8 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 80596.8 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 86238.58 } ] } ] }, { "description": "ACUTE ANXIETY & DELIRIUM STATES - SOI : 1", "code_information": [ { "code": "7561", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7965.17, "maximum": 8522.73, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 8363.43 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 8204.13 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7965.17 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 8283.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7965.17 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 8204.13 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7965.17 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 7965.17 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8522.73 } ] } ] }, { "description": "ACTIN ANTIBODY EACH", "code_information": [ { "code": "86015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 60.25, "discounted_cash": 12.0, "minimum": 8.676, "maximum": 59.045, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.56 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 3.81, "10th_percentile": 3.81, "90th_percentile": 3.81, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.94 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 19.28, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.63 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.89, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 22.75, "10th_percentile": 22.75, "90th_percentile": 22.75, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 31.01 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.94 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.86, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.5, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 24.12, "10th_percentile": 24.12, "90th_percentile": 24.12, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 32.56 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.81, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.85 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.01, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ADD IHC", "code_information": [ { "code": "88341", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 348.1, "minimum": 50.1264, "maximum": 341.138, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 96.61 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 50.13, "10th_percentile": 50.13, "90th_percentile": 50.13, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 94.77 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 92.01 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.85 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 320.95, "10th_percentile": 320.95, "90th_percentile": 320.95, "count": "1 through 10" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 580.85, "10th_percentile": 580.85, "90th_percentile": 580.85, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 92.01 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 94.77 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 92.01 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 92.01 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 96.61 } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "836", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10121.0, "minimum": 3151.2, "maximum": 16193.68, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9134.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 9134.58, "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": 16193.68, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9134.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 9408.62, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 9408.62, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 14675.52, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9774.0, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 10627.1, "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": 13157.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9408.62, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 9134.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14675.52, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 9134.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12256.59, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 12145.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 16193.68, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 10048.04, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12134.13, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11889.2, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10121.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13789.7 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 9134.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 14757.17 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 9134.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8951.89, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 10121.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 10829.52, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 8908.72 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12256.59, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ACUTE BRONCHITIS AND RELATED SYMPTOMS - SOI : 2", "code_information": [ { "code": "1452", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5042.965, "maximum": 5395.97, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 5295.11 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5194.25 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5042.97 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 5244.68 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5042.97 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 5194.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5042.97 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 5042.97 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5395.97 } ] } ] }, { "description": "ACUMED 2.7 BONE TAP #MS-CT27", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "Adenocard", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "67457085502", "type": "NDC" }, { "code": "J0153", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 113.71, "10th_percentile": 113.71, "90th_percentile": 113.71, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 106.06, "10th_percentile": 106.06, "90th_percentile": 212.13, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 224.95, "10th_percentile": 224.95, "90th_percentile": 224.95, "count": "1 through 10" } ] } ] }, { "description": "ACUTE MAJOR EYE INFECTIONS WITHOUT CCMCC", "code_information": [ { "code": "122", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6720.0, "minimum": 3026.79, "maximum": 12150.0, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6084.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 6084.84, "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": 10752.78, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6084.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 6267.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 6267.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 9744.71, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6510.78, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 7056.51, "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": 8736.64, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6267.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 6084.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9744.71, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 6084.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8138.51, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 8064.59, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 10752.78, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 6693.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8057.2, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7894.56, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6720.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3026.79 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 6084.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 9508.97 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 6084.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5963.14, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 6720.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 7190.92, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3187.73 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8138.51, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ACUTE HEPATITS PANEL", "code_information": [ { "code": "80074", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 78.7, "discounted_cash": 47.0, "minimum": 11.3328, "maximum": 77.126, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.74 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 11.34, "10th_percentile": 9.07, "90th_percentile": 11.34, "count": "54" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.21 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 76.21, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.42 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.95 }, { "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 Duals - My Care", "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": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 72.56, "10th_percentile": 58.05, "90th_percentile": 72.56, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 50.96, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 182.6, "10th_percentile": 102.59, "90th_percentile": 601.66, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 66.81, "10th_percentile": 54.15, "90th_percentile": 67.68, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 26.42 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 71.3, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 57.16, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.21 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 52.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 70.59, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 26.42 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 69.16, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.42 }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 71.77, "10th_percentile": 57.42, "90th_percentile": 71.77, "count": "12" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 27.74 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.68, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.87 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 71.21, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ACUMED 2.7X8 CRUCIFORM SCREW", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION - SOI : 2", "code_information": [ { "code": "1902", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6081.472, "maximum": 6507.18, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 6385.55 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 6263.92 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6081.47 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 6324.73 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6081.47 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 6263.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6081.47 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 6081.47 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6507.18 } ] } ] }, { "description": "ACUTE KIDNEY INJURY - SOI : 3", "code_information": [ { "code": "4693", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9109.776, "maximum": 9747.46, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 9565.26 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 9383.07 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 9109.78 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 9474.17 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 9109.78 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 9383.07 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9109.78 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 9109.78 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9747.46 } ] } ] }, { "description": "ACUMED 3.0X16 NON LOCKING SCRW", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "Adjmt/revj ext fixj sys anes", "code_information": [ { "code": "20693", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7059.42, "discounted_cash": 6831.0, "minimum": 2117.826, "maximum": 7059.42, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2863.09 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2808.55 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6831.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 6831.29, "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": 7059.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2726.75 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6831.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2781.29 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 7036.23, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 7036.23, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7059.42, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7059.42, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 7059.42, "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": 7059.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6831.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6831.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7059.42, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2726.75 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6831.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7059.42, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 7059.42, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2808.55 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 7059.42, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7059.42, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2219.22 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7059.42, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2726.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6831.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6831.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 6831.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2863.09 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6694.66, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6831.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7059.42, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7059.42, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CCMCC", "code_information": [ { "code": "282", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6228.0, "minimum": 2232.1, "maximum": 9966.192, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 5643.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 5643.94, "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": 9966.19, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5643.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 5813.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 5813.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 9031.86, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6039.02, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 6540.31, "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": 8097.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5813.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 5643.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9031.86, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 5643.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7543.16, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 7474.64, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 9966.19, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 6208.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7467.79, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7317.05, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6228.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9006.07 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 5643.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 8750.23 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 5643.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5531.06, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 6228.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 6664.89, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5385.46 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7543.16, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ACUTE KIDNEY INJURY - SOI : 4", "code_information": [ { "code": "4694", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17416.031, "maximum": 18635.15, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 18286.83 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 17938.51 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 17416.03 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 18112.67 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 17416.03 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 17938.51 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 17416.03 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 17416.03 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 18635.15 } ] } ] }, { "description": "ACUMED 3.5X12 NON LOCKING SCRW", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "ADJUSTMENT DISORDERS & NEUROSES EXCEPT DEPRESSIVE DIAGNOSES - SOI : 3", "code_information": [ { "code": "7553", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14171.934, "maximum": 15163.97, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 14880.53 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 14597.09 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 14171.93 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 14738.81 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 14171.93 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 14597.09 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 14171.93 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 14171.93 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 15163.97 } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC", "code_information": [ { "code": "284", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5986.0, "minimum": 2100.8, "maximum": 9578.544, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 5426.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 5426.66, "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": 9578.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5426.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 5589.46, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 5589.46, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 8680.56, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5806.53, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 6285.92, "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": 7782.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5589.46, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 5426.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8680.56, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 5426.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7249.76, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 7183.91, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 9578.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 5969.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7177.32, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7032.45, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5986.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8041.14 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 5426.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 8376.31 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 5426.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5318.13, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 5986.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 6405.65, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5193.53 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7249.76, "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": 25681.825, "maximum": 27479.55, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 26965.92 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 26452.28 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 25681.83 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 26709.1 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 25681.83 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 26452.28 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 25681.83 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 25681.83 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 27479.55 } ] } ] }, { "description": "ACUMED HUB CAP SCREW COVER", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "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": 24.1 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.64 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.95 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.41 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.95 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.64 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.95 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.95 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.1 } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CCMCC", "code_information": [ { "code": "285", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5255.0, "minimum": 1706.9, "maximum": 8408.064, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 4770.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 4770.58, "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": 8408.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 4770.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 4913.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 4913.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 7619.81, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5104.52, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 5517.79, "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": 6831.55, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 4913.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 4770.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7619.81, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 4770.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6363.85, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 6306.05, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 8408.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 5247.64, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6300.27, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6173.1, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5255.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6092.69 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 4770.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7247.29 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 4770.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 4675.17, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 5255.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 5622.89, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3935.19 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6363.85, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA - SOI : 3", "code_information": [ { "code": "6903", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 51139.176, "maximum": 54718.92, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 53696.13 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 52673.35 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 51139.18 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 53184.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 51139.18 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 52673.35 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 51139.18 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 51139.18 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 54718.92 } ] } ] }, { "description": "ACUMED PLATE TACK", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "ADM Pfizer covid vacc 3rd 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": 24.1 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.64 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.95 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.41 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.95 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.64 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.95 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.95 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.1 } ] } ] }, { "description": "ADAMST 13 ACTIVITY", "code_information": [ { "code": "85397", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 500.0, "discounted_cash": 30.0, "minimum": 30.2428, "maximum": 490.0, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 66.32 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.05 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 49.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.16 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 64.42 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 31.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 31.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 44.75, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 33.02, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 32.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 43.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 44.75, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.16 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 37.03, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.05 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 45.73, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 63.16 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 44.81, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.16 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 66.32 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.24, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 33.02, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 46.14, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH CC", "code_information": [ { "code": "835", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16913.0, "minimum": 5777.2, "maximum": 27061.68, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15226.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 15226.3, "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": 27061.68, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15226.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 15683.09, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 15683.09, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 24524.65, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16292.14, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 17759.23, "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": 21987.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15683.09, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 15226.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24524.65, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 15226.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20482.31, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 20296.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 27061.68, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 16748.93, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20277.66, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 19868.35, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16913.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19728.9 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 15226.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 25240.27 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 15226.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14921.77, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 16913.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 18097.5, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 19608.29 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 20482.31, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ACUMED:AT2-C12", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "ADRENAL AND PITUITARY PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "615", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11530.0, "minimum": 1969.5, "maximum": 18449.328, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10398.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 10398.9, "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": 18449.33, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10398.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 10710.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 10710.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 16719.7, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11126.82, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 12107.37, "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": 14990.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10710.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 10398.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16719.7, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 10398.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 13963.84, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 13837.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 18449.33, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 11438.79, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 13824.31, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 13545.27, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11530.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16118.4 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 10398.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 16932.93 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 10398.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10190.92, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 11530.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 12337.99, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 10045.55 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13963.84, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "834", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 43604.0, "minimum": 12342.2, "maximum": 89030.3, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 39163.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 39163.7, "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": 69767.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 39163.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 40338.61, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 40338.61, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 63226.51, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 41905.16, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 45784.71, "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": 56685.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 40338.61, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 39163.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 63226.51, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 39163.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 52805.04, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 52325.39, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 69767.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 43080.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 52277.42, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 51222.19, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 43604.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 89030.3 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 39163.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 66433.28 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 39163.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 38380.43, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 43604.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 46656.8, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 34314.39 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 52805.04, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ADRENAL PROCEDURES - SOI : 1", "code_information": [ { "code": "4011", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12736.906, "maximum": 13628.49, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 13373.75 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 13119.01 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 12736.91 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 13246.38 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 12736.91 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 13119.01 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12736.91 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 12736.91 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 13628.49 } ] } ] }, { "description": "ADDITIONAL CML FISH - 88271 - 3000353", "code_information": [ { "code": "88271", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 166.32, "discounted_cash": 21.0, "minimum": 12.6014, "maximum": 2572.9704, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "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": 34.27, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 22.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 22.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.06, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 22.92, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 22.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 29.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 31.06, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 32.07, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 25.7, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 23.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.74, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 112.76 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.1, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.99, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22.92, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.28 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.02, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ADDITIONAL PATHOGEN", "code_information": [ { "code": "87046", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 137.81, "discounted_cash": 9.0, "minimum": 8.5, "maximum": 135.0538, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.48 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 39.69, "10th_percentile": 39.69, "90th_percentile": 39.69, "count": "16" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.03 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "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": 15.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.36 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.81 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.69, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 254.12, "10th_percentile": 254.12, "90th_percentile": 254.12, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.1, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 9.91, "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": 13.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.69, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.36 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.13, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 11.33, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.03 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 10.38, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 13.99, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.36 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 13.71, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 251.37, "10th_percentile": 251.37, "90th_percentile": 251.37, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.48 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.25, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.1, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.5 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.11, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ACUTE & SUBACUTE ENDOCARDITIS - SOI : 2", "code_information": [ { "code": "1932", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7089.408, "maximum": 7585.67, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 7443.88 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7302.09 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7089.41 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 7372.98 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7089.41 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 7302.09 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7089.41 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 7089.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7585.67 } ] } ] }, { "description": "ADRENAL PROCEDURES - SOI : 2", "code_information": [ { "code": "4012", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12736.906, "maximum": 13628.49, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 13373.75 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 13119.01 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 12736.91 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 13246.38 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 12736.91 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 13119.01 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12736.91 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 12736.91 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 13628.49 } ] } ] }, { "description": "ADDITIONAL KARYOTYPED", "code_information": [ { "code": "88280", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 102.57, "discounted_cash": 33.0, "minimum": 14.7701, "maximum": 274.057, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 53.55, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.47, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 35.81, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 48.53, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 50.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 40.16, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 49.6, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 102.57 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 48.6, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 33.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.8, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.12 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50.04, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ADENOSINE DEAMINASE (PF)", "code_information": [ { "code": "84311", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 220.0, "discounted_cash": 8.0, "minimum": 4.297, "maximum": 215.6, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.58 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.26 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.96, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.11 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 8.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 8.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.75, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.67, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 8.51, "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": 11.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.75, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 12.13, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.26 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 8.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11.76, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.58 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.94, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.67, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.29 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ACUTE ABDOMINAL SERIES - 74022 - 3220002", "code_information": [ { "code": "74022", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 835.79, "discounted_cash": 98.0, "minimum": 22.4, "maximum": 819.0742, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 80.09 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 637.71, "10th_percentile": 637.71, "90th_percentile": 637.71, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.57 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "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": 157.47, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.81 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 101.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 101.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 142.71, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 105.31, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 103.34, "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": 137.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 142.71, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 147.33, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 118.1, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.57 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 108.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 145.86, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 142.92, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 80.09 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.45, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 105.31, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.4 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 147.14, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "AFB SMEAR", "code_information": [ { "code": "87206", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 35.0, "discounted_cash": 5.0, "minimum": 2.4077, "maximum": 34.3, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 5.39, "10th_percentile": 5.04, "90th_percentile": 16.83, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "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": 8.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 5.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 5.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 7.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 30.1, "10th_percentile": 30.1, "90th_percentile": 30.1, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.93, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.99, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.36 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 31.92, "10th_percentile": 31.92, "90th_percentile": 31.92, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.28, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.85 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ADENOVIRUS ANTIBODY", "code_information": [ { "code": "86603", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 34.55, "discounted_cash": 12.0, "minimum": 4.9752, "maximum": 38.2984, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.56 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.94 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 20.59, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.63 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.77, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 31.01 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.44, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.94 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.07, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.69, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "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 Duals", "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": 32.56 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.61, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.24, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH CC", "code_information": [ { "code": "289", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13942.0, "minimum": 6696.3, "maximum": 22950.0, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12561.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 12561.9, "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": 22308.27, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12561.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 12938.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 12938.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 20216.87, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13441.23, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 14639.8, "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": 18125.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12938.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 12561.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20216.87, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 12561.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 16884.57, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 16731.2, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 22308.27, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 13818.09, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 16715.87, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 16378.45, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13942.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7528.85 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 12561.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 20655.2 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 12561.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12310.66, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 13942.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 14918.66, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7085.64 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16884.57, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "AFTERCARE WITH CCMCC", "code_information": [ { "code": "949", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9887.0, "minimum": 5777.2, "maximum": 24116.6, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8925.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 8925.03, "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": 15819.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8925.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 9192.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 9192.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 14336.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9549.78, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 10381.76, "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": 12853.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9192.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 8925.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14336.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8925.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11973.63, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 11864.87, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 15819.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 9817.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11853.99, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11614.72, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9887.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24116.6 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 8925.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 14396.56 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 8925.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8746.53, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 9887.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 10579.51, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7059.41 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11973.63, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC", "code_information": [ { "code": "288", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21778.0, "minimum": 9716.2, "maximum": 34844.8, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 19588.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 19588.9, "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": 34844.8, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 19588.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 20176.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 20176.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 31578.1, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20960.12, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 22866.9, "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": 28311.4, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 20176.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 19588.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 31578.1, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 19588.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 26373.16, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 26133.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 34844.8, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 21547.79, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 26109.64, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 25582.62, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21778.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29231.6 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 19588.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 32747.73 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 19588.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 19197.12, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 21778.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 23302.46, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 15690.13 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 26373.16, "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": 15181.0, "minimum": 6696.3, "maximum": 24290.432, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13673.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 13673.0, "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": 24290.43, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13673.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 14083.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 14083.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 22013.2, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14630.11, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 15940.6, "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": 19735.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14083.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 13673.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22013.2, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 13673.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18384.82, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 18217.82, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 24290.43, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 15040.3, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18201.12, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17833.73, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15181.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20144.4 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 13673.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 22567.15 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 13673.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13399.54, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 15181.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 16244.23, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 16623.53 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18384.82, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ADJUSTMENT DISORDERS & NEUROSES EXCEPT DEPRESSIVE DIAGNOSES - SOI : 2", "code_information": [ { "code": "7552", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10287.649, "maximum": 11007.78, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 10802.03 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 10596.28 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 10287.65 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 10699.15 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 10287.65 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 10596.28 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10287.65 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 10287.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 11007.78 } ] } ] }, { "description": "ADJUSTMENT DISORDERS & NEUROSES EXCEPT DEPRESSIVE DIAGNOSES - SOI : 1", "code_information": [ { "code": "7551", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7768.259, "maximum": 8312.04, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 8156.67 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 8001.31 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7768.26 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 8078.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7768.26 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 8001.31 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7768.26 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 7768.26 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8312.04 } ] } ] }, { "description": "ACUTE ANXIETY & DELIRIUM STATES - SOI : 2", "code_information": [ { "code": "7562", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9118.767, "maximum": 9757.08, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 9574.71 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 9392.33 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 9118.77 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 9483.52 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 9118.77 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 9392.33 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9118.77 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 9118.77 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9757.08 } ] } ] }, { "description": "AFX LOW-PRO CORT SCREW3.5X16MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "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": 24.1 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.64 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.95 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.41 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.95 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.64 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.95 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.95 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.1 } ] } ] }, { "description": "ADJUSTMENT DISORDERS & NEUROSES EXCEPT DEPRESSIVE DIAGNOSES - SOI : 4", "code_information": [ { "code": "7554", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14171.934, "maximum": 15163.97, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 14880.53 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 14597.09 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 14171.93 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 14738.81 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 14171.93 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 14597.09 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 14171.93 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 14171.93 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 15163.97 } ] } ] }, { "description": "ACUTE ANXIETY & DELIRIUM STATES - SOI : 4", "code_information": [ { "code": "7564", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13225.139, "maximum": 14150.9, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 13886.4 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 13621.89 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 13225.14 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 13754.14 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 13225.14 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 13621.89 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13225.14 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 13225.14 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 14150.9 } ] } ] }, { "description": "ALANINE AMINO (ALT)(SGPT)", "code_information": [ { "code": "84460", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 125.0, "discounted_cash": 5.0, "minimum": 4.77, "maximum": 122.5, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 15.65, "10th_percentile": 15.65, "90th_percentile": 15.66, "count": "25" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "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": 8.48, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.46, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 5.46, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.69, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 100.22, "10th_percentile": 100.22, "90th_percentile": 100.22, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.67, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 5.57, "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": 7.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 93.48, "10th_percentile": 93.48, "90th_percentile": 93.48, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.69, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.93, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.36, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.85, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.7, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 99.13, "10th_percentile": 99.13, "90th_percentile": 99.13, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.19, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.67, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.77 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.92, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ADRENAL PROCEDURES - SOI : 4", "code_information": [ { "code": "4014", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12736.906, "maximum": 13628.49, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 13373.75 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 13119.01 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 12736.91 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 13246.38 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 12736.91 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 13119.01 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12736.91 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 12736.91 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 13628.49 } ] } ] }, { "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": 24.1 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.64 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.95 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.41 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.95 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.95 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.95 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.1 } ] } ] }, { "description": "ACUTE BRONCHITIS AND RELATED SYMPTOMS - SOI : 1", "code_information": [ { "code": "1451", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4140.229, "maximum": 4430.05, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 4347.24 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4264.44 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4140.23 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 4305.84 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4140.23 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 4264.44 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4140.23 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 4140.23 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4430.05 } ] } ] }, { "description": "ADVANCED LOCKING SCREW 5X40MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "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": 24.1 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.64 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.95 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.41 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.95 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.64 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.95 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.95 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.1 } ] } ] }, { "description": "ACUTE BRONCHITIS AND RELATED SYMPTOMS - SOI : 3", "code_information": [ { "code": "1453", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7894.138, "maximum": 8446.73, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 8288.84 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 8130.96 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7894.14 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 8209.9 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7894.14 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 8130.96 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7894.14 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 7894.14 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8446.73 } ] } ] }, { "description": "ALBUMIN_BODY FLUID", "code_information": [ { "code": "82042", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10.4, "discounted_cash": 7.0, "minimum": 1.4976, "maximum": 13.26, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.4 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.4 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 10.4, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.4 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.4 }, { "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 Duals - My Care", "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": 10.4, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.32, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": 10.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.4, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.4 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 10.4, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.4 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 8.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 10.4, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 10.4 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 10.4, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.4 }, { "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 Duals", "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": 10.4 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.62, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.0 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.4, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "AFTERCARE WITHOUT CCMCC", "code_information": [ { "code": "950", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5480.0, "minimum": 3807.7, "maximum": 19253.8, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 4973.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 4973.1, "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": 8769.36, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 4973.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 5122.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 5122.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 7947.23, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5321.22, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 5754.89, "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": 7125.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5122.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 4973.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7947.23, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 4973.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6637.31, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 6577.02, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 8769.36, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 5470.41, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6570.99, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6438.35, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5480.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19253.8 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 4973.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7595.8 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 4973.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 4873.64, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 5480.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 5864.51, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4108.25 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6637.31, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ADRENAL 21-HYDROXYLASE AB", "code_information": [ { "code": "83519", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 197.4, "discounted_cash": 18.0, "minimum": 4.032, "maximum": 255.4272, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 29.44, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.69, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 26.68, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.54, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.08, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.27, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.72, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.03, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.56 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.51, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ACUTE KIDNEY INJURY - SOI : 1", "code_information": [ { "code": "4691", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3955.006, "maximum": 4231.86, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 4152.76 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4073.66 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3955.01 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 4113.21 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3955.01 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 4073.66 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3955.01 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 3955.01 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4231.86 } ] } ] }, { "description": "ALCOHOL & DRUG DEPENDENCE W REHAB OR REHABDETOX THERAPY - SOI : 1", "code_information": [ { "code": "7721", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4493.591, "maximum": 4808.14, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 4718.27 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4628.4 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4493.59 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 4673.33 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4493.59 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 4628.4 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4493.59 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 4493.59 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4808.14 } ] } ] }, { "description": "AICD LEAD PROCEDURES", "code_information": [ { "code": "265", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28928.0, "minimum": 5383.3, "maximum": 46286.112, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 26002.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 26002.0, "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": 46286.11, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 26002.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 26782.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 26782.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 41946.79, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27822.14, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 30375.26, "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": 37607.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 26782.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 26002.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 41946.79, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 26002.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 35032.8, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 34714.58, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 46286.11, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 28602.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 34682.76, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 33982.68, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28928.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 38710.9 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 26002.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 43783.84 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 26002.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 25481.96, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 28928.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 30953.84, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 25005.25 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 35032.8, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ADRENAL ANTIBODY", "code_information": [ { "code": "86255", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 58.64, "discounted_cash": 12.0, "minimum": 3.0528, "maximum": 1274.0, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 3.06, "10th_percentile": 3.06, "90th_percentile": 3.06, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 19.28, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.89, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.86, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.5, "additional_payer_notes": "145.21% 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 Duals", "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": 11.81, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.85 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.01, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC", "code_information": [ { "code": "280", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13136.0, "minimum": 5383.3, "maximum": 21018.608, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11839.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 11839.1, "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": 21018.61, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11839.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 12194.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 12194.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 19048.11, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12667.84, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 13793.46, "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": 17077.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12194.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 18450.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4500.0, "10th_percentile": 4500.0, "90th_percentile": 4500.0, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 11839.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19048.11, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 11839.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15908.46, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 15763.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 21018.61, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 13023.01, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15749.51, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15431.6, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13136.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14893.5 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 11839.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 19411.21 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 11839.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11602.32, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 13136.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 14056.19, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 8460.89 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15908.46, "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": 11785.616, "maximum": 12610.61, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 12374.9 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 12139.18 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 11785.62 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 12257.04 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 11785.62 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 12139.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11785.62 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 11785.62 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12610.61 } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC", "code_information": [ { "code": "283", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16090.0, "minimum": 4201.6, "maximum": 27644.9, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14488.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 14488.0, "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": 25744.43, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14488.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 14922.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 14922.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 23330.89, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15502.16, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 16894.78, "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": 20917.35, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14922.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 14488.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23330.89, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 14488.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 19485.32, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 19308.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 25744.43, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 15936.8, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 19290.62, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18901.24, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16090.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27644.9 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 14488.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 23969.66 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 14488.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14198.24, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 16090.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 17216.59, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 12052.72 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19485.32, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL ABUSE & DEPENDENCE - SOI : 4", "code_information": [ { "code": "7754", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 24244.1, "maximum": 25941.19, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 25456.31 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 24971.42 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 24244.1 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 25213.86 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 24244.1 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 24971.42 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 24244.1 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 24244.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 25941.19 } ] } ] }, { "description": "ALBUMIN", "code_information": [ { "code": "82040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80.33, "discounted_cash": 4.0, "minimum": 1.3536, "maximum": 78.7234, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.58 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 11.57, "10th_percentile": 11.57, "90th_percentile": 11.57, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.26 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 7.92, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.11 }, { "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 Duals - My Care", "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": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 74.06, "10th_percentile": 74.06, "90th_percentile": 74.06, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 5.2, "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": 6.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 69.08, "10th_percentile": 69.08, "90th_percentile": 69.08, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 15.79 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.41, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 5.94, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.26 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.34, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.19, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 73.26, "10th_percentile": 73.26, "90th_percentile": 73.26, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.58 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.85, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.46 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.4, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "AEROBIC ISOLATE_ADD MTHD EACH", "code_information": [ { "code": "87077", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 111.21, "discounted_cash": 8.0, "minimum": 7.27, "maximum": 108.9858, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.48 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 16.02, "10th_percentile": 16.01, "90th_percentile": 32.03, "count": "73" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.03 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "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": 12.93, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.36 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.81 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 8.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 8.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 102.54, "10th_percentile": 102.54, "90th_percentile": 205.07, "count": "19" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 8.48, "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": 11.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 211.55, "10th_percentile": 179.15, "90th_percentile": 278.15, "count": "23" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 95.64, "10th_percentile": 95.64, "90th_percentile": 95.64, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 95.64, "10th_percentile": 89.14, "90th_percentile": 95.64, "count": "22" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.36 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 12.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.03 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 8.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11.97, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.36 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11.73, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 101.42, "10th_percentile": 101.42, "90th_percentile": 101.42, "count": "25" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.48 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.92, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.27 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.08, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ALCOHOLIC LIVER DISEASE - SOI : 3", "code_information": [ { "code": "2803", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8452.504, "maximum": 9044.18, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 8875.13 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 8706.08 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 8452.5 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 8790.6 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 8452.5 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 8706.08 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8452.5 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 8452.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9044.18 } ] } ] }, { "description": "AEROSOL TREATMENT", "code_information": [ { "code": "94640", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 958.0, "discounted_cash": 206.0, "minimum": 87.2872, "maximum": 938.84, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 1461.91, "10th_percentile": 730.95, "90th_percentile": 2192.87, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 329.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 206.14, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 883.28, "10th_percentile": 822.85, "90th_percentile": 927.24, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 220.57, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 206.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 823.88, "10th_percentile": 775.73, "90th_percentile": 823.88, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 206.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 308.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 247.37, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 226.75, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 305.5, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 87.29 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 299.34, "additional_payer_notes": "145.21% 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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 873.7, "10th_percentile": 873.7, "90th_percentile": 873.7, "count": "11" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 202.02, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 308.18, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ADDITIONAL CML FISH - 88271 - 3001707", "code_information": [ { "code": "88271", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 237.8, "discounted_cash": 21.0, "minimum": 12.6014, "maximum": 2572.9704, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "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": 34.27, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 22.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 22.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.06, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 22.92, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 22.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 29.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 31.06, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 32.07, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 25.7, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 23.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.74, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 112.76 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.1, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.99, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22.92, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.28 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.02, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL & DRUG DEPENDENCE W REHAB OR REHABDETOX THERAPY - SOI : 4", "code_information": [ { "code": "7724", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6613.763, "maximum": 7076.73, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 6944.45 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 6812.18 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6613.76 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 6878.31 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6613.76 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 6812.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6613.76 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 6613.76 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7076.73 } ] } ] }, { "description": "AFB CONCENTRATION", "code_information": [ { "code": "87015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25.96, "discounted_cash": 6.0, "minimum": 2.9837, "maximum": 35.3388, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.48 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.03 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "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": 10.69, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.36 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.81 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.69, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.15, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "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": 9.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.69, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.36 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 10.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.02, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.03 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 7.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9.9, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.36 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.48 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.55, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.15, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.01 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.99, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ADDITIONAL FISH DNA PROBE", "code_information": [ { "code": "88275", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 164.1, "discounted_cash": 51.0, "minimum": 23.6304, "maximum": 1128.96, "payers_information": [ { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 51.19, "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": 81.9, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 52.73, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 52.73, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 74.23, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 54.77, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 53.75, "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": 71.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 74.23, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 76.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 61.43, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 56.31, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 75.86, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 112.76 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 74.33, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 51.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 51.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.17, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 51.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 54.77, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.07 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 76.53, "additional_payer_notes": "149.50% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.19, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL ABUSE & DEPENDENCE - SOI : 1", "code_information": [ { "code": "7751", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5862.082, "maximum": 6272.43, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 6155.19 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 6037.94 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5862.08 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 6096.57 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5862.08 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 6037.94 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5862.08 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 5862.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6272.43 } ] } ] }, { "description": "AFB CULTURE", "code_information": [ { "code": "87116", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 35.0, "discounted_cash": 10.0, "minimum": 5.04, "maximum": 82.3298, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 10.8, "10th_percentile": 5.04, "90th_percentile": 31.56, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "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": 17.28, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 11.12, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 11.12, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.66, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.56, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 11.34, "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": 15.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 112.68, "10th_percentile": 112.68, "90th_percentile": 112.68, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 30.1, "10th_percentile": 30.1, "90th_percentile": 30.1, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.66, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.17, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 11.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.01, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.36 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.68, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 31.92, "10th_percentile": 31.92, "90th_percentile": 31.92, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.58, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.56, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.72 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.15, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ADDL 100 SQ CM FEET", "code_information": [ { "code": "C5278", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 591.94, "minimum": 177.582, "maximum": 591.94, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 391.5 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 384.05 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 372.86 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 380.32 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 372.86 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 384.05 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 591.94 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 372.86 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 391.5 } ] } ] }, { "description": "Allergen Profile, Food-Grain", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 78.24, "discounted_cash": 5.0, "minimum": 2.3472, "maximum": 454.524, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 63.37, "10th_percentile": 4.98, "90th_percentile": 77.46, "count": "23" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 8.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 405.77, "10th_percentile": 405.77, "90th_percentile": 405.77, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 113.67, "10th_percentile": 113.67, "90th_percentile": 120.05, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 224.29, "10th_percentile": 224.29, "90th_percentile": 224.29, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.58, "additional_payer_notes": "145.21% 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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 374.82, "10th_percentile": 89.19, "90th_percentile": 401.37, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 5.12, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.7 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.8, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL ABUSE & DEPENDENCE - SOI : 2", "code_information": [ { "code": "7752", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7655.866, "maximum": 8191.78, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 8038.66 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7885.54 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7655.87 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 7962.1 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7655.87 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 7885.54 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7655.87 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 7655.87 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8191.78 } ] } ] }, { "description": "AFB IDENTIFICATION", "code_information": [ { "code": "87149", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 81.44, "discounted_cash": 20.0, "minimum": 11.7274, "maximum": 134.4462, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 32.08, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.45, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 29.07, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 30.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 24.06, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 22.06, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 29.71, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.36 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 29.11, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.65, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.05 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.97, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ADDL 100 SQ CM LEGS", "code_information": [ { "code": "C5274", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1982.52, "minimum": 372.86, "maximum": 1973.3454, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 391.5 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 384.05 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 372.86 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 380.32 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 372.86 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 384.05 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1973.35 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 372.86 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 391.5 } ] } ] }, { "description": "Allergen Profile, Vegetable II", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 117.36, "discounted_cash": 5.0, "minimum": 2.3472, "maximum": 454.524, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 63.37, "10th_percentile": 4.98, "90th_percentile": 77.46, "count": "23" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 8.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 405.77, "10th_percentile": 405.77, "90th_percentile": 405.77, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 113.67, "10th_percentile": 113.67, "90th_percentile": 120.05, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 224.29, "10th_percentile": 224.29, "90th_percentile": 224.29, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.58, "additional_payer_notes": "145.21% 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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 374.82, "10th_percentile": 89.19, "90th_percentile": 401.37, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 5.12, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.7 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.8, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ALCOHOLIC LIVER DISEASE - SOI : 2", "code_information": [ { "code": "2802", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5573.458, "maximum": 5963.6, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 5852.13 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5740.66 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5573.46 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 5796.4 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5573.46 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 5740.66 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5573.46 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 5573.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5963.6 } ] } ] }, { "description": "AFP VALUE", "code_information": [ { "code": "82105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28.51, "discounted_cash": 16.0, "minimum": 2.9304, "maximum": 47.9024, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 4.11, "10th_percentile": 4.11, "90th_percentile": 4.11, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 26.83, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.94, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.12, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 18.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.85, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.35, "additional_payer_notes": "145.21% 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 Duals", "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": 16.43, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.09 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.07, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ADDL 100SQCM OR LESS, HEAD,FEE", "code_information": [ { "code": "15278", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 583.32, "minimum": 174.996, "maximum": 583.32, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 391.5 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 384.05 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 372.86 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 380.32 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 372.86 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 384.05 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 583.32 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 372.86 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 391.5 } ] } ] }, { "description": "ALLERGENS, PERENNIAL", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 247.76, "discounted_cash": 5.0, "minimum": 2.3472, "maximum": 454.524, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 63.37, "10th_percentile": 4.98, "90th_percentile": 77.46, "count": "23" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 8.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 405.77, "10th_percentile": 405.77, "90th_percentile": 405.77, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 113.67, "10th_percentile": 113.67, "90th_percentile": 120.05, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 224.29, "10th_percentile": 224.29, "90th_percentile": 224.29, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.58, "additional_payer_notes": "145.21% 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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 374.82, "10th_percentile": 89.19, "90th_percentile": 401.37, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 5.12, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.7 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.8, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ALDOSTERONE LCMS, SERUM", "code_information": [ { "code": "82088", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21.15, "discounted_cash": 40.0, "minimum": 3.0456, "maximum": 184.8966, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 9.06, "10th_percentile": 9.06, "90th_percentile": 9.06, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 21.15, "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": 21.15, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 21.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 21.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.15, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.15, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 21.15, "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": 21.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 24.87, "10th_percentile": 24.87, "90th_percentile": 24.87, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 21.15, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.15, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 21.15, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 21.15, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.15, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 21.15 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.15, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 57.36, "10th_percentile": 57.36, "90th_percentile": 57.36, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 21.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.15, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 21.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 21.15, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.15 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.15, "additional_payer_notes": "149.50% 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": 9388.0, "minimum": 4858.1, "maximum": 16650.0, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8477.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 8477.8, "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": 15021.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8477.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 8732.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 8732.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 13613.64, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9071.25, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 9858.16, "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": 12205.34, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8732.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 8477.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13613.64, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8477.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11369.74, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 11266.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 15021.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 9325.58, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11256.14, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11028.93, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9388.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15248.3 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 8477.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 13626.94 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 8477.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8308.24, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 9388.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 10045.93, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 9207.88 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11369.74, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ADENOVIRUS GROUP AB,QN", "code_information": [ { "code": "86603", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 39.08, "discounted_cash": 12.0, "minimum": 4.9752, "maximum": 38.2984, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 20.59, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.77, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.66, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.44, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.07, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.69, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.61, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.24, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS - SOI : 2", "code_information": [ { "code": "8112", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4559.228, "maximum": 4878.37, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 4787.19 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4696.0 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4559.23 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 4741.6 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4559.23 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 4696.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4559.23 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 4559.23 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4878.37 } ] } ] }, { "description": "ALDOSTERONE (3 SPECIMENS)", "code_information": [ { "code": "82088", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 188.67, "discounted_cash": 40.0, "minimum": 3.0456, "maximum": 184.8966, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 9.06, "10th_percentile": 9.06, "90th_percentile": 9.06, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 65.2, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 43.6, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 24.87, "10th_percentile": 24.87, "90th_percentile": 24.87, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 59.09, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 61.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 48.9, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 44.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 60.39, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 37.2 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 59.17, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 57.36, "10th_percentile": 57.36, "90th_percentile": 57.36, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.94, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.68 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 60.92, "additional_payer_notes": "149.50% 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": 6862.0, "minimum": 3676.4, "maximum": 12600.0, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6212.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 6212.12, "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": 10979.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6212.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 6398.48, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 6398.48, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 9950.49, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6646.97, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 7205.53, "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": 8921.13, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6398.48, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 6212.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9950.49, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 6212.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8310.38, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 8234.89, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 10979.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 6833.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8227.34, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8061.27, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6862.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9767.65 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 6212.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 9727.99 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 6212.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6087.88, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 6862.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 7342.78, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5732.03 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8310.38, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "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": 24.1 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.64 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.95 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.41 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.95 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.64 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.95 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.95 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.1 } ] } ] }, { "description": "ALLERGIC REACTIONS WITH MCC", "code_information": [ { "code": "915", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13744.0, "minimum": 4858.1, "maximum": 21990.864, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12384.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 12384.0, "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": 21990.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12384.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 12755.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 12755.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 19929.22, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13250.88, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 14431.5, "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": 17867.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12755.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 12384.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19929.22, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 12384.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 16644.34, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 16493.15, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 21990.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 13622.4, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 16478.03, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 16145.42, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13744.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15053.8 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 12384.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 20349.04 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 12384.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12136.32, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 13744.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 14706.39, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 8514.74 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16644.34, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ALKALINE PHOSPHATASE ISO", "code_information": [ { "code": "84075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7.99, "discounted_cash": 5.0, "minimum": 1.1506, "maximum": 19.6, "payers_information": [ { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 7.99 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.66 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "149.50% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 1.16, "10th_percentile": 1.16, "90th_percentile": 1.16, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 7.99, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.54, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.51, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.68, "additional_payer_notes": "148.20% of Medicare Rates" } ] } ] }, { "description": "afx Cortical Screw 3.5 x 26MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "ADRENAL AND PITUITARY PROCEDURES WITH CCMCC", "code_information": [ { "code": "614", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17744.0, "minimum": 3545.1, "maximum": 28391.488, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15971.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 15971.7, "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": 28391.49, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15971.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 16450.85, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 16450.85, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 25729.79, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17089.72, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 18631.91, "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": 23068.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16450.85, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 15971.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25729.79, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 15971.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21488.81, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 21293.62, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 28391.49, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 17568.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21274.1, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20844.68, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17744.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26579.3 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 15971.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 26522.97 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 15971.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15652.27, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 17744.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 18986.81, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 16478.55 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 21488.81, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS WITHOUT MCC", "code_information": [ { "code": "916", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5783.0, "minimum": 2363.4, "maximum": 9253.616, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 5244.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 5244.53, "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": 9253.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5244.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 5401.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 5401.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 8386.09, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5611.65, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 6072.69, "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": 7518.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5401.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 5244.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8386.09, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 5244.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7003.83, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 6940.21, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 9253.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 5768.98, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6933.85, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6793.89, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5783.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4318.26 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 5244.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 8062.9 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 5244.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5139.64, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 5783.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 6188.36, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 2521.28 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7003.83, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "Allergen Profile, Food-Basic", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 97.8, "discounted_cash": 5.0, "minimum": 2.3472, "maximum": 454.524, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 63.37, "10th_percentile": 4.98, "90th_percentile": 77.46, "count": "23" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 8.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 405.77, "10th_percentile": 405.77, "90th_percentile": 405.77, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 113.67, "10th_percentile": 113.67, "90th_percentile": 120.05, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 224.29, "10th_percentile": 224.29, "90th_percentile": 224.29, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.58, "additional_payer_notes": "145.21% 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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 374.82, "10th_percentile": 89.19, "90th_percentile": 401.37, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 5.12, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.7 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.8, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "afx cortical screw 2.7 x 40mm", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "ADRENAL PROCEDURES - SOI : 3", "code_information": [ { "code": "4013", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12736.906, "maximum": 13628.49, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 13373.75 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 13119.01 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 12736.91 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 13246.38 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 12736.91 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 13119.01 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12736.91 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 12736.91 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 13628.49 } ] } ] }, { "description": "ALLERGEN PROFILE, SHELLFISH", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 97.8, "discounted_cash": 5.0, "minimum": 2.3472, "maximum": 454.524, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 63.37, "10th_percentile": 4.98, "90th_percentile": 77.46, "count": "23" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 8.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 405.77, "10th_percentile": 405.77, "90th_percentile": 405.77, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 113.67, "10th_percentile": 113.67, "90th_percentile": 120.05, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 224.29, "10th_percentile": 224.29, "90th_percentile": 224.29, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.58, "additional_payer_notes": "145.21% 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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 374.82, "10th_percentile": 89.19, "90th_percentile": 401.37, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 5.12, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.7 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.8, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "AICD GENERATOR PROCEDURES", "code_information": [ { "code": "245", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 36332.0, "minimum": 5645.9, "maximum": 58131.408, "payers_information": [ { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 33620.85, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 52681.59, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34926.51, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 38148.74, "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": 47231.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33620.85, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 32641.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 52681.59, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 32641.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 43998.21, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 43598.56, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 58131.41, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 35905.76, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 43558.59, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 42679.35, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 36332.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 53030.4 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 32641.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 55209.6 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 32641.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 31988.77, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 36332.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 38875.38, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 34256.39 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 43998.21, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 32641.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 32641.6, "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": 58131.41, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 32641.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 33620.85, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "afx Locking Screw 2.7 x 14mm", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "ALLG SPEC IGE CRUDE EXTRAC EA - 86003 - 3010637", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 111.47, "discounted_cash": 5.0, "minimum": 2.3472, "maximum": 454.524, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 63.37, "10th_percentile": 4.98, "90th_percentile": 77.46, "count": "23" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 8.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 405.77, "10th_percentile": 405.77, "90th_percentile": 405.77, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 113.67, "10th_percentile": 113.67, "90th_percentile": 120.05, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 224.29, "10th_percentile": 224.29, "90th_percentile": 224.29, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.58, "additional_payer_notes": "145.21% 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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 374.82, "10th_percentile": 89.19, "90th_percentile": 401.37, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 5.12, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.7 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.8, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN, SINGLE", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30.69, "discounted_cash": 5.0, "minimum": 2.3472, "maximum": 454.524, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 3.48, "10th_percentile": 3.48, "90th_percentile": 3.49, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 8.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 22.31, "10th_percentile": 22.31, "90th_percentile": 22.31, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 30.69 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.58, "additional_payer_notes": "145.21% 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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 22.07, "10th_percentile": 22.07, "90th_percentile": 22.07, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 5.12, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.7 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.8, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "AFX LOWPRO CORT SCREW 3.5X57.5", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "ALLG SPEC IGE CRUDE XTRC EA", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 296.53, "discounted_cash": 5.0, "minimum": 2.3472, "maximum": 454.524, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 63.37, "10th_percentile": 4.98, "90th_percentile": 77.46, "count": "23" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 8.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 405.77, "10th_percentile": 405.77, "90th_percentile": 405.77, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 113.67, "10th_percentile": 113.67, "90th_percentile": 120.05, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 224.29, "10th_percentile": 224.29, "90th_percentile": 224.29, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.58, "additional_payer_notes": "145.21% 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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 374.82, "10th_percentile": 89.19, "90th_percentile": 401.37, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 5.12, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.7 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.8, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS - SOI : 4", "code_information": [ { "code": "8114", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14224.983, "maximum": 15220.73, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 14936.23 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 14651.73 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 14224.98 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 14793.98 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 14224.98 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 14651.73 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 14224.98 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 14224.98 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 15220.73 } ] } ] }, { "description": "ALCOHOL & DRUG DEPENDENCE W REHAB OR REHABDETOX THERAPY - SOI : 2", "code_information": [ { "code": "7722", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4746.249, "maximum": 5078.49, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 4983.56 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4888.64 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4746.25 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 4936.1 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4746.25 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 4888.64 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4746.25 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 4746.25 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5078.49 } ] } ] }, { "description": "ALLOGENEIC BONE MARROW TRANSPLANT- SOI : 1", "code_information": [ { "code": "0071", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 88876.082, "maximum": 95097.41, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 93319.89 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 91542.36 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 88876.08 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 92431.13 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 88876.08 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 91542.36 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 88876.08 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 88876.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 95097.41 } ] } ] }, { "description": "Aimmer, 5.5 cortical screw", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "ALCOHOL & DRUG DEPENDENCE W REHAB OR REHABDETOX THERAPY - SOI : 3", "code_information": [ { "code": "7723", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6613.763, "maximum": 7076.73, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 6944.45 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 6812.18 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6613.76 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 6878.31 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6613.76 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 6812.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6613.76 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 6613.76 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7076.73 } ] } ] }, { "description": "ALLOGENEIC BONE MARROW TRANSPLANT- SOI : 3", "code_information": [ { "code": "0073", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 110975.145, "maximum": 118743.41, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 116523.9 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 114304.4 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 110975.15 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 115414.15 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 110975.15 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 114304.4 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 110975.15 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 110975.15 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 118743.41 } ] } ] }, { "description": "ALLOGRAFT CANCELLOUS CHIPS 5CC", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "AIRWAY INHALATION TREATMENT", "code_information": [ { "code": "94640", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 919.8, "discounted_cash": 206.0, "minimum": 87.2872, "maximum": 938.84, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 1461.91, "10th_percentile": 730.95, "90th_percentile": 2192.87, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 329.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 206.14, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 883.28, "10th_percentile": 822.85, "90th_percentile": 927.24, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 220.57, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 206.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 823.88, "10th_percentile": 775.73, "90th_percentile": 823.88, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 206.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 308.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 247.37, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 226.75, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 305.5, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 87.29 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 299.34, "additional_payer_notes": "145.21% 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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 873.7, "10th_percentile": 873.7, "90th_percentile": 873.7, "count": "11" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 202.02, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 308.18, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY", "code_information": [ { "code": "895", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11658.0, "minimum": 7195.47, "maximum": 34200.0, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10513.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 10513.5, "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": 18653.81, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10513.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 10828.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 10828.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 16905.01, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11249.45, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 12241.56, "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": 15156.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10828.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 10513.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16905.01, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 10513.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14118.6, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 13990.36, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 18653.81, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 11564.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 13977.53, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 13695.39, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11658.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7195.47 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 10513.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 17130.18 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 10513.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10303.23, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 11658.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 12474.73, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 10150.03 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14118.6, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ALLOGENEIC BONE MARROW TRANSPLANT- SOI : 4", "code_information": [ { "code": "0074", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 227175.502, "maximum": 243077.79, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 238534.28 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 233990.77 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 227175.5 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 236262.52 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 227175.5 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 233990.77 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 227175.5 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 227175.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 243077.79 } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC", "code_information": [ { "code": "896", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14242.0, "minimum": 5116.8, "maximum": 22787.488, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12830.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 12830.6, "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": 22787.49, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12830.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 13215.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 13215.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 20651.16, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13728.74, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 14954.29, "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": 18514.83, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13215.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 12830.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20651.16, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 12830.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17247.28, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 17090.62, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 22787.49, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 14113.66, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17074.95, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 16730.29, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14242.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11460.9 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 12830.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 21117.46 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 12830.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12573.99, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 14242.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 15239.13, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6873.0 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 17247.28, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ALPH-2-MACROGLOBULINS, QN", "code_information": [ { "code": "83883", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 91.13, "discounted_cash": 13.0, "minimum": 8.208, "maximum": 166.6588, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 25.72, "10th_percentile": 13.13, "90th_percentile": 41.91, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "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": 21.76, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 14.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 14.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 14.28, "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": 19.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 19.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.36, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 16.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.96, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.16, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.75, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 114.0, "10th_percentile": 114.0, "90th_percentile": 114.0, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.33, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.24 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.33, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ALPHA - 1 ANTITRYPSIN PHENOTYP", "code_information": [ { "code": "82104", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30.09, "discounted_cash": 14.0, "minimum": 4.333, "maximum": 29.4882, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.6 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.11 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 23.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.87 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.47, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 31.22, "10th_percentile": 31.22, "90th_percentile": 31.22, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 24.38 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.65, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 17.35, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.11 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 15.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.43, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.0, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "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 Duals", "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": 25.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.17, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.01 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.62, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA", "code_information": [ { "code": "894", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5396.0, "minimum": 2132.0, "maximum": 9450.0, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 4897.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 4897.16, "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": 8633.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 4897.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 5044.07, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 5044.07, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 7824.45, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5239.96, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 5665.98, "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": 7015.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5044.07, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 4897.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7824.45, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 4897.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6534.76, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 6475.4, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 8633.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 5386.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6469.47, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6338.88, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5396.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3771.76 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 4897.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7465.11 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 4897.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 4799.22, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 5396.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 5773.9, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 2339.48 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6534.76, "additional_payer_notes": "121.10% 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": 7481.0, "minimum": 3086.48, "maximum": 14850.0, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6766.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 6766.94, "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": 11969.68, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6766.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 6969.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 6969.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 10847.52, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7240.63, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 7855.1, "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": 9725.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6969.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 6766.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10847.52, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 6766.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9059.55, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 8977.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 11969.68, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 7443.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8969.03, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8787.99, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7481.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 6766.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 10682.76 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 6766.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6631.6, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 7481.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 8004.72, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3086.48 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9059.55, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ALPHA 2 MACROGLOBULIN", "code_information": [ { "code": "83883", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 170.06, "discounted_cash": 13.0, "minimum": 8.208, "maximum": 166.6588, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 25.72, "10th_percentile": 13.13, "90th_percentile": 41.91, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "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": 21.76, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 14.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 14.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 14.28, "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": 19.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 19.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.36, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 16.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.96, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.16, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.75, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 114.0, "10th_percentile": 114.0, "90th_percentile": 114.0, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.33, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.24 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.33, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ALPHA-1-ANTITRYPSIN", "code_information": [ { "code": "82103", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22.5, "discounted_cash": 13.0, "minimum": 3.24, "maximum": 87.7688, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.5 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 3.24, "10th_percentile": 3.24, "90th_percentile": 5.22, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.5 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 21.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.5 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.5 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.38, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 10.88, "10th_percentile": 10.88, "90th_percentile": 10.88, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 19.35, "10th_percentile": 19.35, "90th_percentile": 31.18, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 22.5 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.12, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.5 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.92, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.5 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.52, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.5 }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 20.52, "10th_percentile": 20.52, "90th_percentile": 20.52, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 22.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.17, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.1 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.09, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ALFOODFISH", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 114.1, "discounted_cash": 5.0, "minimum": 2.3472, "maximum": 454.524, "payers_information": [ { "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": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 22.31, "10th_percentile": 22.31, "90th_percentile": 22.31, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.58, "additional_payer_notes": "145.21% 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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 22.07, "10th_percentile": 22.07, "90th_percentile": 22.07, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 5.12, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.7 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.8, "additional_payer_notes": "149.50% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 3.48, "10th_percentile": 3.48, "90th_percentile": 3.49, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 8.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% 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 Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOLIC LIVER DISEASE - SOI : 1", "code_information": [ { "code": "2801", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4249.924, "maximum": 4547.42, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 4462.42 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4377.42 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4249.92 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 4419.92 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4249.92 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 4377.42 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4249.92 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 4249.92 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4547.42 } ] } ] }, { "description": "ALPHA GAL IGE", "code_information": [ { "code": "86008", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 116.09, "discounted_cash": 17.0, "minimum": 16.14, "maximum": 454.524, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 28.69, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.19, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 26.0, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.84, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 21.52, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 19.72, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.57, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.04, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.57, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.14 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.81, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ALPHA-2 MACROGLOBULIN", "code_information": [ { "code": "83883", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 57.0, "discounted_cash": 13.0, "minimum": 8.208, "maximum": 166.6588, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 25.72, "10th_percentile": 13.13, "90th_percentile": 41.91, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "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": 21.76, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 14.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 14.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 14.28, "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": 19.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 19.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.36, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 16.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.96, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.16, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.75, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 114.0, "10th_percentile": 114.0, "90th_percentile": 114.0, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.33, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.24 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.33, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ALCOHOLIC LIVER DISEASE - SOI : 4", "code_information": [ { "code": "2804", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 20060.402, "maximum": 21464.63, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 21063.42 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 20662.21 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 20060.4 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 20862.82 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 20060.4 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 20662.21 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 20060.4 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 20060.4 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 21464.63 } ] } ] }, { "description": "ALTERATION IN CONSCIOUSNESS - SOI : 3", "code_information": [ { "code": "0523", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9164.623, "maximum": 9806.15, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 9622.85 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 9439.56 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 9164.62 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 9531.21 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 9164.62 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 9439.56 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9164.62 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 9164.62 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9806.15 } ] } ] }, { "description": "ALPHA-A-ANTITRYPSIN TOTAL", "code_information": [ { "code": "82103", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 89.56, "discounted_cash": 13.0, "minimum": 3.24, "maximum": 87.7688, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 3.24, "10th_percentile": 3.24, "90th_percentile": 5.22, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 21.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.38, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 10.88, "10th_percentile": 10.88, "90th_percentile": 10.88, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 19.35, "10th_percentile": 19.35, "90th_percentile": 31.18, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.12, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.92, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.52, "additional_payer_notes": "145.21% 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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 20.52, "10th_percentile": 20.52, "90th_percentile": 20.52, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 13.17, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.1 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.09, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ALKALINE PHOSPHATASE", "code_information": [ { "code": "84075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20.0, "discounted_cash": 5.0, "minimum": 1.1506, "maximum": 19.6, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.58 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.26 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 8.29, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.11 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.54, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 15.79 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.26 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.68, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.58 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.66 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ALDOLASE", "code_information": [ { "code": "82085", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10.0, "discounted_cash": 9.0, "minimum": 1.44, "maximum": 10.0, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.0 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 1.44, "10th_percentile": 1.44, "90th_percentile": 1.44, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.0 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 10.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.0 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.0 }, { "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 Duals - My Care", "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": 10.0, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.0, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 10.0, "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": 10.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.0, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.0 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 10.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.0 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 10.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 10.0, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 10.0 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 10.0, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.0 }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 7.3, "10th_percentile": 7.3, "90th_percentile": 7.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 10.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.52, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": 10.0, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.74 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.0, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ALPHA-FETOPROTEIN SERUM", "code_information": [ { "code": "82105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 48.88, "discounted_cash": 16.0, "minimum": 2.9304, "maximum": 47.9024, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.6 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 2.94, "10th_percentile": 2.34, "90th_percentile": 2.94, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.11 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 26.83, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.87 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.94, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 14.66, "10th_percentile": 14.66, "90th_percentile": 14.66, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 17.5, "10th_percentile": 17.5, "90th_percentile": 17.5, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 24.38 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.12, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.11 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 18.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.85, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.35, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 18.56, "10th_percentile": 18.56, "90th_percentile": 18.56, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 25.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.43, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.09 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.07, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ALKALINE PHOSPHATASE, ISO", "code_information": [ { "code": "84080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22.81, "discounted_cash": 14.0, "minimum": 3.2846, "maximum": 22.81, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.81 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.81 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 22.81, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.81 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.81 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.81, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 22.81 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 22.13, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 17.74, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.81 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.81 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.46, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.81 }, { "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 Duals", "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": 22.81 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.3 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.1, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ALDOSTERONE", "code_information": [ { "code": "82088", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 62.89, "discounted_cash": 40.0, "minimum": 3.0456, "maximum": 184.8966, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 9.06, "10th_percentile": 9.06, "90th_percentile": 9.06, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 62.89, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 43.6, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 59.09, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 61.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 48.9, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 44.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 60.39, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 37.2 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 59.17, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 21.02, "10th_percentile": 21.02, "90th_percentile": 36.48, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.94, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.68 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 60.92, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "AMMONIA - 82140 - 3000660", "code_information": [ { "code": "82140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 198.0, "discounted_cash": 14.0, "minimum": 10.4904, "maximum": 194.04, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.6 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.11 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 23.31, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.87 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.59, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 170.28, "10th_percentile": 170.28, "90th_percentile": 170.28, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 24.38 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.11 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 16.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.59, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.16, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 180.58, "10th_percentile": 180.58, "90th_percentile": 180.58, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.28, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.11 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.78, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ALPHA-FETOPROTEIN UE3", "code_information": [ { "code": "82677", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 41.09, "discounted_cash": 24.0, "minimum": 5.3726, "maximum": 53.9, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 5.92, "10th_percentile": 5.92, "90th_percentile": 5.92, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 38.69, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 25.87, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 36.2, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 29.02, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 26.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 35.83, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 29.56 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 35.11, "additional_payer_notes": "145.21% 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 Duals", "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": 23.7, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.76 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.15, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN PANEL, FOOD-BERRY", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 39.12, "discounted_cash": 5.0, "minimum": 2.3472, "maximum": 454.524, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 63.37, "10th_percentile": 4.98, "90th_percentile": 77.46, "count": "23" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 8.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 405.77, "10th_percentile": 405.77, "90th_percentile": 405.77, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 113.67, "10th_percentile": 113.67, "90th_percentile": 120.05, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 224.29, "10th_percentile": 224.29, "90th_percentile": 224.29, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.58, "additional_payer_notes": "145.21% 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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 374.82, "10th_percentile": 89.19, "90th_percentile": 401.37, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 5.12, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.7 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.8, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "AMPHETAMINE RFX", "code_information": [ { "code": "80324", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 105.0, "minimum": 7.3382, "maximum": 372.4, "payers_information": [ { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 40.47 } ] } ] }, { "description": "ALPRAZOLAM (XANAX)", "code_information": [ { "code": "80346", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 112.0, "minimum": 7.6723, "maximum": 237.9538, "payers_information": [ { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 40.47 } ] } ] }, { "description": "Allergen Profile, Food-Citrus", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 65.2, "discounted_cash": 5.0, "minimum": 2.3472, "maximum": 454.524, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 63.37, "10th_percentile": 4.98, "90th_percentile": 77.46, "count": "23" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 8.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 405.77, "10th_percentile": 405.77, "90th_percentile": 405.77, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 113.67, "10th_percentile": 113.67, "90th_percentile": 120.05, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 224.29, "10th_percentile": 224.29, "90th_percentile": 224.29, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.58, "additional_payer_notes": "145.21% 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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 374.82, "10th_percentile": 89.19, "90th_percentile": 401.37, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 5.12, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.7 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.8, "additional_payer_notes": "149.50% 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": 39149.0, "minimum": 14836.9, "maximum": 62638.928, "payers_information": [ { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 39149.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 41889.78, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 19382.76 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 47409.84, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 35168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 35168.1, "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": 62638.93, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 35168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 36223.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 36223.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 56766.53, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 37629.87, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 41106.8, "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": 50894.13, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 36223.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 35168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 56766.53, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 35168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 47409.84, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 46979.2, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 62638.93, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 38684.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 46936.13, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 45988.72, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 39149.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 38689.3 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 35168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 59557.49 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 35168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 34464.74, "additional_payer_notes": "98.00% of Medicare Rates" } ] } ] }, { "description": "ALTERATION IN CONSCIOUSNESS - SOI : 1", "code_information": [ { "code": "0521", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4338.04, "maximum": 4641.7, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 4554.94 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4468.18 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4338.04 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 4511.56 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4338.04 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 4468.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4338.04 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 4338.04 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4641.7 } ] } ] }, { "description": "Allergen Profile, Mini-Panel", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 158.48, "discounted_cash": 5.0, "minimum": 2.3472, "maximum": 454.524, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.56 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 63.37, "10th_percentile": 4.98, "90th_percentile": 77.46, "count": "23" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.94 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 8.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.63 }, { "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 Duals - My Care", "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": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 405.77, "10th_percentile": 405.77, "90th_percentile": 405.77, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 113.67, "10th_percentile": 113.67, "90th_percentile": 120.05, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 224.29, "10th_percentile": 224.29, "90th_percentile": 224.29, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 31.01 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.94 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.58, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 374.82, "10th_percentile": 89.19, "90th_percentile": 401.37, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 32.56 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.7 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.8, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "Allergen Profile, Food-Milk", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 78.24, "discounted_cash": 5.0, "minimum": 2.3472, "maximum": 454.524, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 63.37, "10th_percentile": 4.98, "90th_percentile": 77.46, "count": "23" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 8.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 405.77, "10th_percentile": 405.77, "90th_percentile": 405.77, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 113.67, "10th_percentile": 113.67, "90th_percentile": 120.05, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 224.29, "10th_percentile": 224.29, "90th_percentile": 224.29, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.58, "additional_payer_notes": "145.21% 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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 374.82, "10th_percentile": 89.19, "90th_percentile": 401.37, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 5.12, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.7 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.8, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "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": 11414.0, "minimum": 5777.2, "maximum": 19800.0, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10294.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 10294.2, "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": 18262.4, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10294.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 10603.03, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 10603.03, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 16550.3, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11014.79, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 11984.7, "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": 14838.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10603.03, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 10294.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16550.3, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 10294.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 13822.35, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 13696.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 18262.4, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 11323.62, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 13684.24, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 13408.03, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11414.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16385.3 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 10294.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 16752.62 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 10294.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10088.32, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 11414.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 12212.98, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7333.26 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13822.35, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ALUMINUM, PLASMA", "code_information": [ { "code": "82108", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 53.28, "discounted_cash": 25.0, "minimum": 7.6723, "maximum": 52.2144, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.87 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.43 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 40.77, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.78 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.22 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 27.26, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 21.78 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 38.14, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 30.58, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.43 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 28.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 37.76, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 21.78 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 37.0, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.78 }, { "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 Duals", "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": 22.87 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.97, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.93 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.09, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN PROFILE, MOLD", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 156.48, "discounted_cash": 5.0, "minimum": 2.3472, "maximum": 454.524, "payers_information": [ { "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": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 405.77, "10th_percentile": 405.77, "90th_percentile": 405.77, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 113.67, "10th_percentile": 113.67, "90th_percentile": 120.05, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 224.29, "10th_percentile": 224.29, "90th_percentile": 224.29, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.58, "additional_payer_notes": "145.21% 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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 374.82, "10th_percentile": 89.19, "90th_percentile": 401.37, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 5.12, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.7 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.8, "additional_payer_notes": "149.50% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 63.37, "10th_percentile": 4.98, "90th_percentile": 77.46, "count": "23" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 8.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% 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 Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN PROFILE, PEANUT, IgE", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16.3, "discounted_cash": 5.0, "minimum": 2.3472, "maximum": 454.524, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 3.48, "10th_percentile": 3.48, "90th_percentile": 3.49, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 8.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 22.31, "10th_percentile": 22.31, "90th_percentile": 22.31, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "148.20% 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": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.58, "additional_payer_notes": "145.21% 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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 22.07, "10th_percentile": 22.07, "90th_percentile": 22.07, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 5.12, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.7 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.8, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "Amputation of finger/thumb", "code_information": [ { "code": "26951", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3109.28, "discounted_cash": 3080.0, "minimum": 932.784, "maximum": 3109.28, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3109.28 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3109.28 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 3109.28, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3109.28 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3080.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3109.28 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 3109.28, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 3109.28, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3109.28, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3109.28, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 3109.28, "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": 3109.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3080.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3080.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3109.28, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3109.28 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 3109.28, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 3109.28, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3109.28 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3109.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 3109.28, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1569.29 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 3109.28, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3109.28 }, { "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 Duals", "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": 3109.28 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3018.78, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": 3109.28, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3109.28, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "Amikacin Random, Serum", "code_information": [ { "code": "80150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40.0, "discounted_cash": 15.0, "minimum": 5.76, "maximum": 39.2, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.83 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.34 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 24.13, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.09 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.14, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 24.6 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 22.57, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.1, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.34 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 22.35, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "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 Duals", "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": 25.83 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.57 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.54, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ALLG SPEC IGE CRUDE EXTRAC EA - 86003 - 3010633", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 230.0, "discounted_cash": 5.0, "minimum": 2.3472, "maximum": 454.524, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 63.37, "10th_percentile": 4.98, "90th_percentile": 77.46, "count": "23" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 8.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 405.77, "10th_percentile": 405.77, "90th_percentile": 405.77, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 113.67, "10th_percentile": 113.67, "90th_percentile": 120.05, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 224.29, "10th_percentile": 224.29, "90th_percentile": 224.29, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.58, "additional_payer_notes": "145.21% 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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 374.82, "10th_percentile": 89.19, "90th_percentile": 401.37, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 5.12, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.7 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.8, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS - SOI : 1", "code_information": [ { "code": "8111", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3639.408, "maximum": 3894.17, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 3821.38 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3748.59 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3639.41 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 3784.98 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3639.41 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 3748.59 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3639.41 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 3639.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3894.17 } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB EXCEPT TOES - SOI : 1", "code_information": [ { "code": "3051", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9622.285, "maximum": 10295.84, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 10103.4 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 9910.95 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 9622.29 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 10007.18 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 9622.29 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 9910.95 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9622.29 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 9622.29 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10295.84 } ] } ] }, { "description": "AMITRIPTYLINE", "code_information": [ { "code": "80335", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 32.0, "minimum": 3.456, "maximum": 391.706, "payers_information": [ { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.0 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 32.0 } ] } ] }, { "description": "ALLG SPEC IGE RECOMB EA LC", "code_information": [ { "code": "86008", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 463.8, "discounted_cash": 17.0, "minimum": 16.14, "maximum": 454.524, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.56 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 3.49, "10th_percentile": 3.48, "90th_percentile": 3.49, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.94 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 28.69, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.63 }, { "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 Duals - My Care", "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": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 22.31, "10th_percentile": 22.31, "90th_percentile": 22.31, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.19, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 353.8, "10th_percentile": 353.8, "90th_percentile": 353.8, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 31.01 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.84, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 21.52, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.94 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 19.72, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.57, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.04, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 22.07, "10th_percentile": 22.07, "90th_percentile": 22.07, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 32.56 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.57, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.14 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.81, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS - SOI : 3", "code_information": [ { "code": "8113", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7710.714, "maximum": 8250.46, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 8096.25 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7942.04 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7710.71 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 8019.14 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7710.71 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 7942.04 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7710.71 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 7710.71 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8250.46 } ] } ] }, { "description": "Amputation toe & metatarsal", "code_information": [ { "code": "28810", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1162.68, "discounted_cash": 3080.0, "minimum": 348.804, "maximum": 1162.68, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1162.68 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1162.68 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1162.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 1162.68, "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": 1162.68, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1162.68 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1162.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1162.68 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 1162.68, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 1162.68, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1162.68, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1162.68, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 1162.68, "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": 1162.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1162.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1162.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1162.68, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1162.68 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1162.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1162.68, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1162.68, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1162.68 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1162.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1162.68, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1162.68 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1162.68, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1162.68 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1162.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1162.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 1162.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1162.68 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1162.68, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1162.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1162.68, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1162.68, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ALLOGENEIC BONE MARROW TRANSPLANT- SOI : 2", "code_information": [ { "code": "0072", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 88876.082, "maximum": 95097.41, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 93319.89 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 91542.36 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 88876.08 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 92431.13 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 88876.08 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 91542.36 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 88876.08 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 88876.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 95097.41 } ] } ] }, { "description": "ALLG SPEC IGE CRUDE EXTRAC EA - 86003 - 3010635", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 184.3, "discounted_cash": 5.0, "minimum": 2.3472, "maximum": 454.524, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 63.37, "10th_percentile": 4.98, "90th_percentile": 77.46, "count": "23" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 8.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 405.77, "10th_percentile": 405.77, "90th_percentile": 405.77, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 113.67, "10th_percentile": 113.67, "90th_percentile": 120.05, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 224.29, "10th_percentile": 224.29, "90th_percentile": 224.29, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.58, "additional_payer_notes": "145.21% 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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 374.82, "10th_percentile": 89.19, "90th_percentile": 401.37, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 5.12, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.7 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.8, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANAEROBE IDENTIFICATION", "code_information": [ { "code": "87076", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 97.76, "discounted_cash": 8.0, "minimum": 7.27, "maximum": 95.8048, "payers_information": [ { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.36 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11.73, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.48 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.92, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.27 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.08, "additional_payer_notes": "149.50% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.48 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.03 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "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": 12.93, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.36 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.81 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 8.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 8.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 8.48, "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": 11.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.36 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 12.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.03 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 8.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11.97, "additional_payer_notes": "148.20% of Medicare Rates" } ] } ] }, { "description": "AMPHETAMINE", "code_information": [ { "code": "80307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 31.72, "discounted_cash": 62.0, "minimum": 2.9664, "maximum": 1127.0, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 31.72, "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": 31.72, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 31.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 31.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 31.72, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 31.72, "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": 31.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 14.17, "10th_percentile": 14.17, "90th_percentile": 17.72, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 31.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.72, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 31.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 31.72, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.72, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.72 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.72, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 31.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 31.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.72, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 31.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 31.72, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.72 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.72, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "Alpha Subunit (Free)", "code_information": [ { "code": "83520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 211.76, "discounted_cash": 17.0, "minimum": 7.5514, "maximum": 820.064, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "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": 27.63, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.04, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.48, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 18.13, "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": 24.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 25.04, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.85, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 19.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.59, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.08, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.92, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.48, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.54 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.82, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ALLG SPEC IGE CRUDE XTRC EA LC", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 463.8, "discounted_cash": 5.0, "minimum": 2.3472, "maximum": 454.524, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 3.48, "10th_percentile": 3.48, "90th_percentile": 3.49, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 8.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 22.31, "10th_percentile": 22.31, "90th_percentile": 22.31, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.58, "additional_payer_notes": "145.21% 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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 22.07, "10th_percentile": 22.07, "90th_percentile": 22.07, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 5.12, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.7 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.8, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANAL AND PERINEAL PROCEDURES- SOI : 3", "code_information": [ { "code": "2263", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15865.914, "maximum": 16976.53, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 16659.21 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 16341.89 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 15865.91 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 16500.55 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 15865.91 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 16341.89 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15865.91 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 15865.91 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 16976.53 } ] } ] }, { "description": "AMPHETAMINES", "code_information": [ { "code": "80324", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 380.0, "minimum": 7.3382, "maximum": 372.4, "payers_information": [ { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 40.47 } ] } ] }, { "description": "AMIKICIN SERUM PEAK", "code_information": [ { "code": "80150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40.0, "discounted_cash": 15.0, "minimum": 5.76, "maximum": 39.2, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 24.13, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.14, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 21.87, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 22.57, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.1, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 22.35, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.57 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.54, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ALLG SPEC IGE MULTIALLG SCR", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18.93, "discounted_cash": 5.0, "minimum": 2.3472, "maximum": 454.524, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 63.37, "10th_percentile": 4.98, "90th_percentile": 77.46, "count": "23" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 8.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 405.77, "10th_percentile": 405.77, "90th_percentile": 405.77, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 113.67, "10th_percentile": 113.67, "90th_percentile": 120.05, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 224.29, "10th_percentile": 224.29, "90th_percentile": 224.29, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 18.93 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.58, "additional_payer_notes": "145.21% 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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 374.82, "10th_percentile": 89.19, "90th_percentile": 401.37, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 5.12, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.7 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.8, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "Anesth lower arm surgery", "code_information": [ { "code": "01810", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2790.05, "minimum": 269.4596, "maximum": 2734.249, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 282.93 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 277.54 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 269.46 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 274.85 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 269.46 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 277.54 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 269.46 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 269.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 282.93 } ] } ] }, { "description": "Amputate metacarpal bone", "code_information": [ { "code": "26910", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4286.51, "discounted_cash": 3080.0, "minimum": 812.74, "maximum": 4286.51, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 853.38 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 837.12 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 4286.51, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 812.74 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3080.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 828.99 }, { "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 Duals - My Care", "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": 4286.51, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3296.02, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": 4286.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3080.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3080.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4286.51, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 812.74 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4286.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 3696.47, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 837.12 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3388.43, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4286.51, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2569.5 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4286.51, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 812.74 }, { "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 Duals", "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": 853.38 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3018.78, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4286.51, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "AMIODARONE", "code_information": [ { "code": "80299", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 32.6, "discounted_cash": 18.0, "minimum": 4.6944, "maximum": 1425.9, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 29.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.94, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 27.03, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.9, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.37, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 20.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.62, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.07, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.27, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.78 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.87, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ALLG SPEC IGE RECOMB EA RFLX", "code_information": [ { "code": "86008", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 330.0, "discounted_cash": 17.0, "minimum": 16.14, "maximum": 454.524, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 3.49, "10th_percentile": 3.48, "90th_percentile": 3.49, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 28.69, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 22.31, "10th_percentile": 22.31, "90th_percentile": 22.31, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.19, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 353.8, "10th_percentile": 353.8, "90th_percentile": 353.8, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 26.0, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.84, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 21.52, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 19.72, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.57, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.04, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 22.07, "10th_percentile": 22.07, "90th_percentile": 22.07, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.57, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.14 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.81, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS - SOI : 1", "code_information": [ { "code": "1981", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3614.232, "maximum": 3867.23, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 3794.94 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3722.66 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3614.23 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 3758.8 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3614.23 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 3722.66 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3614.23 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 3614.23 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3867.23 } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [ { "code": "475", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18402.0, "minimum": 7484.1, "maximum": 29444.032, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16561.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 16561.7, "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": 29444.03, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16561.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 17058.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 17058.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 26683.65, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17721.02, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 19322.65, "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": 23923.28, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17058.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 16561.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 26683.65, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 16561.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 22285.45, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 22083.02, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 29444.03, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 18217.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 22062.78, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21617.44, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18402.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20441.6 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 16561.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 27538.25 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 16561.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16230.47, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 18402.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 19690.7, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 11391.8 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 22285.45, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "AMMONIA - 82140 - 3008866", "code_information": [ { "code": "82140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 72.85, "discounted_cash": 14.0, "minimum": 10.4904, "maximum": 194.04, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 10.49, "10th_percentile": 10.49, "90th_percentile": 10.5, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 23.31, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.59, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 62.65, "10th_percentile": 62.65, "90th_percentile": 62.65, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 21.13, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 16.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.59, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.16, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 66.44, "10th_percentile": 66.44, "90th_percentile": 66.44, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.28, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.11 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.78, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ALLOGENEIC BONE MARROW TRANSPLANT", "code_information": [ { "code": "014", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 94789.0, "minimum": 36238.8, "maximum": 151662.976, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 85068.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 85068.0, "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": 151662.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 85068.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 87620.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 87620.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 137444.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 91022.76, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 99528.83, "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": 123226.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 87620.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 85068.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 137444.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 85068.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 114789.91, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 113747.23, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 151662.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 93574.8, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 113642.96, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 111349.06, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 94789.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 114827.0 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 85068.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 145428.61 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 85068.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 83366.64, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 94789.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 101424.62, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 60297.68 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 114789.91, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ANGIOTENSIN CONV. ENZ (ACE)", "code_information": [ { "code": "82164", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18.35, "discounted_cash": 14.0, "minimum": 2.6424, "maximum": 18.35, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.35 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.35 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 18.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.35 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.35 }, { "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 Duals - My Care", "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": 18.35, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.62, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": 18.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 15.78, "10th_percentile": 15.78, "90th_percentile": 15.78, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.35, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.35 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.35, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 17.52, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.35 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.35, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 18.35 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.35, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.35 }, { "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 Duals", "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": 18.35 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.31, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.35, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "476", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9812.0, "minimum": 3282.5, "maximum": 15700.656, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8858.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 8858.23, "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": 15700.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8858.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 9123.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 9123.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 14228.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9478.31, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 10303.56, "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": 12756.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9123.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 8858.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14228.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8858.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11883.43, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 11775.49, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 15700.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 9744.05, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11764.7, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11527.23, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9812.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8411.66 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 8858.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 14281.6 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 8858.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8681.07, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 9812.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 10499.81, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7012.46 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11883.43, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB EXCEPT TOES - SOI : 4", "code_information": [ { "code": "3054", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 27823.577, "maximum": 29771.23, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 29214.76 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 28658.28 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 27823.58 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 28936.52 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 27823.58 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 28658.28 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 27823.58 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 27823.58 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 29771.23 } ] } ] }, { "description": "ALLOGRAFT DBM GEL 5CC", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "ANKLE BILATERAL (MIN 3 V) - 73610 - 3240009", "code_information": [ { "code": "73610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 765.93, "discounted_cash": 81.0, "minimum": 17.97, "maximum": 764.0864, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80.29, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 87.67, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.97 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 122.49, "additional_payer_notes": "149.50% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 584.41, "10th_percentile": 584.4, "90th_percentile": 584.41, "count": "21" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "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": 131.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 84.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 84.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 118.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 706.19, "10th_percentile": 706.19, "90th_percentile": 706.19, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 87.67, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 86.03, "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": 114.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 229.78, "10th_percentile": 229.78, "90th_percentile": 454.77, "count": "23" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 658.7, "10th_percentile": 658.7, "90th_percentile": 658.7, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 118.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 122.65, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 98.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 90.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 121.42, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 118.97, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 698.53, "10th_percentile": 698.53, "90th_percentile": 698.53, "count": "37" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB EXCEPT TOES - SOI : 3", "code_information": [ { "code": "3053", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17047.384, "maximum": 18240.7, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 17899.75 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 17558.81 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 17047.38 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 17729.28 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 17047.38 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 17558.81 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 17047.38 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 17047.38 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 18240.7 } ] } ] }, { "description": "AMYLASE SERUM", "code_information": [ { "code": "82150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14.68, "discounted_cash": 6.0, "minimum": 2.1139, "maximum": 120.54, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 2.12, "10th_percentile": 2.11, "90th_percentile": 2.12, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 10.37, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 13.53, "10th_percentile": 13.53, "90th_percentile": 13.53, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.93, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.4, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 7.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9.6, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 14.68 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9.41, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 13.39, "10th_percentile": 13.39, "90th_percentile": 13.39, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.35, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.83 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.69, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ALPHA SUBUNIT,FREE", "code_information": [ { "code": "83519", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 222.66, "discounted_cash": 18.0, "minimum": 4.032, "maximum": 255.4272, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 29.44, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.69, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 26.68, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.54, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.08, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.27, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.72, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.03, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.56 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.51, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANTEPARTUM WITH O.R. PROCEDURE- SOI : 3", "code_information": [ { "code": "5473", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11315.366, "maximum": 12107.44, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 11881.13 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 11654.83 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 11315.37 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 11767.98 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 11315.37 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 11654.83 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11315.37 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 11315.37 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12107.44 } ] } ] }, { "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": 27903.0, "minimum": 13130.0, "maximum": 45000.0, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 25082.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 25082.3, "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": 44645.2, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25082.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 25834.77, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 25834.77, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 40459.71, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26838.06, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 29298.41, "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": 36274.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 25834.77, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 25082.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 40459.71, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 25082.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 33790.84, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 33483.9, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 44645.2, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 27590.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 33453.21, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 32777.95, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27903.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24004.1 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 25082.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 42201.03 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 25082.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24580.65, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 27903.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 29856.48, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 13647.51 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 33790.84, "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": 8012.825, "maximum": 8573.72, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 8413.47 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 8253.21 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 8012.83 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 8333.34 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 8012.83 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 8253.21 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8012.83 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 8012.83 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8573.72 } ] } ] }, { "description": "ALPHA-FETOPROTEIN B-hCG", "code_information": [ { "code": "84702", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25.59, "discounted_cash": 15.0, "minimum": 2.88, "maximum": 25.59, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 3.68, "10th_percentile": 3.68, "90th_percentile": 3.68, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 24.08, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 18.44, "10th_percentile": 18.44, "90th_percentile": 18.44, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 21.82, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 22.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 16.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 22.3, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 25.59 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.85, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "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": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.55 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.5, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANTEPARTUM WITHOUT O.R. PROCEDURE- SOI : 1", "code_information": [ { "code": "5661", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3071.151, "maximum": 3286.13, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 3224.71 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3163.29 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3071.15 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 3194.0 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3071.15 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 3163.29 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3071.15 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 3071.15 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3286.13 } ] } ] }, { "description": "Amputation of toe", "code_information": [ { "code": "28820", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2790.05, "discounted_cash": 3080.0, "minimum": 534.02, "maximum": 2790.05, "payers_information": [ { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 544.7 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 2790.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 2790.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2790.05, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2790.05, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 2790.05, "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": 2790.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2790.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2790.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2790.05, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 534.02 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2790.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2790.05, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2790.05, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 550.04 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2790.05, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2790.05, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2357.25 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2790.05, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 534.02 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2790.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2790.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 2790.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 560.72 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2790.05, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2790.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2790.05, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2790.05, "additional_payer_notes": "149.50% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 560.72 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 550.04 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2790.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 2790.05, "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": 2790.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 534.02 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2790.05, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "349", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7385.0, "minimum": 2232.1, "maximum": 11816.624, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6681.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 6681.15, "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": 11816.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6681.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 6881.58, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 6881.58, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 10708.82, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7148.83, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 7754.66, "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": 9601.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6881.58, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 6681.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10708.82, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 6681.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8943.71, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 8862.47, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 11816.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 7349.27, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8854.34, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8675.62, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7385.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7215.03 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 6681.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 10535.13 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 6681.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6547.53, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 7385.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 7902.37, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6174.79 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8943.71, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ALPHA-FETOPROTEIN INHIBIN A", "code_information": [ { "code": "86336", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26.49, "discounted_cash": 15.0, "minimum": 3.8146, "maximum": 319.284, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.49 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 3.81, "10th_percentile": 3.81, "90th_percentile": 3.81, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.49 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 15.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.49 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.49 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.61, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.68, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 16.37, "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": 21.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 22.61, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.49 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 23.34, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.71, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.49 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 17.15, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 23.1, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 26.49 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 22.64, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.49 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 15.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.28, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 15.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.68, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.03 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.31, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "Amputation thru metatarsal", "code_information": [ { "code": "28805", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 930.01, "discounted_cash": 3080.0, "minimum": 279.003, "maximum": 930.01, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 930.01 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 930.01 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 930.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 930.01, "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": 930.01, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 930.01 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 930.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 930.01 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 930.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 930.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 930.01, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 930.01, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 930.01, "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": 930.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 930.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 930.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 930.01, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 930.01 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 930.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 930.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 930.01, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 930.01 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 930.01, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 930.01, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 930.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 930.01, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 930.01 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 930.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 930.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 930.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 930.01 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 930.01, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 930.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 930.01, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 930.01, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANALYS GENE REARRANGE TRB AMP", "code_information": [ { "code": "81340", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 874.6, "discounted_cash": 208.0, "minimum": 125.9424, "maximum": 857.108, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 164.3 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 161.17 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 208.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 208.92, "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": 334.27, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 156.48 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 208.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 159.61 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 215.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 215.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 302.93, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 223.54, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 219.37, "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": 292.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 208.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 208.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 302.93, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 156.48 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 208.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 312.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 250.7, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 161.17 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 229.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 309.62, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 156.48 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 303.37, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 156.48 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 208.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 208.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 208.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 164.3 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 204.74, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 208.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 223.54, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.03 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 312.34, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ALPHA-FETOPROTEIN TUMOR MARKER", "code_information": [ { "code": "82105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20.35, "discounted_cash": 16.0, "minimum": 2.9304, "maximum": 47.9024, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 2.94, "10th_percentile": 2.34, "90th_percentile": 2.94, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 20.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": 20.35, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.94, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": 20.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 14.66, "10th_percentile": 14.66, "90th_percentile": 14.66, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 17.5, "10th_percentile": 17.5, "90th_percentile": 17.5, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 20.35, "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.35, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.12, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 18.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.35, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 20.35 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.35, "additional_payer_notes": "145.21% 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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 18.56, "10th_percentile": 18.56, "90th_percentile": 18.56, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 16.43, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.09 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.35, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANTERIOR LATERAL PLATE - 6 HOL", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "ANA FLUID", "code_information": [ { "code": "86038", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 65.71, "discounted_cash": 12.0, "minimum": 1.7568, "maximum": 509.6, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 2.04, "10th_percentile": 1.41, "90th_percentile": 2.04, "count": "68" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 19.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 13.0, "10th_percentile": 13.0, "90th_percentile": 13.0, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.94, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 12.13, "10th_percentile": 8.39, "90th_percentile": 12.13, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.53, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.51, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.3, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.56, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 12.86, "10th_percentile": 12.86, "90th_percentile": 12.86, "count": "21" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.88 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.07, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANCA TITER EA AB LC", "code_information": [ { "code": "86037", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 84.08, "discounted_cash": 12.0, "minimum": 10.85, "maximum": 82.3984, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.56 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.94 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 19.28, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.63 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.89, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 31.01 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.94 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.86, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.5, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "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 Duals", "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": 32.56 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.81, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.85 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.01, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ALTERATION IN CONSCIOUSNESS - SOI : 2", "code_information": [ { "code": "0522", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5753.286, "maximum": 6156.02, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 6040.95 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5925.88 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5753.29 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 5983.42 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5753.29 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 5925.88 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5753.29 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 5753.29 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6156.02 } ] } ] }, { "description": "ANTI DNA, (DOUBLE STRANDED) AB", "code_information": [ { "code": "86225", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28.5, "discounted_cash": 13.0, "minimum": 3.6346, "maximum": 509.6, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.5 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 4.1, "10th_percentile": 3.29, "90th_percentile": 6.5, "count": "47" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.5 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "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": 21.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.5 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.5 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 14.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 14.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.92, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 26.28, "10th_percentile": 26.28, "90th_percentile": 26.28, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 19.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 19.61, "10th_percentile": 19.61, "90th_percentile": 24.51, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 19.92, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.5 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.57, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 16.49, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.5 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 15.11, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.36, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 28.5 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.95, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 25.99, "10th_percentile": 20.79, "90th_percentile": 25.99, "count": "13" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.47, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.37 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.54, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANAL AND PERINEAL PROCEDURES- SOI : 1", "code_information": [ { "code": "2261", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6861.926, "maximum": 7342.26, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 7205.02 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7067.78 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6861.93 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 7136.4 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6861.93 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 7067.78 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6861.93 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 6861.93 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7342.26 } ] } ] }, { "description": "ANDROSTENEDIONE", "code_information": [ { "code": "82157", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40.0, "discounted_cash": 29.0, "minimum": 5.76, "maximum": 40.0, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.04 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.45 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 40.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.56 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.15 }, { "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 Duals - My Care", "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": 40.0, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 31.33, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": 40.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 40.0, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.56 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 40.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 35.14, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.45 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 32.21, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 40.0, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 29.56 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 40.0, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.56 }, { "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 Duals", "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": 31.04 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.69, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.35 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.0, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ALTERATION IN CONSCIOUSNESS - SOI : 4", "code_information": [ { "code": "0524", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 19959.698, "maximum": 21356.88, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 20957.68 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 20558.49 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 19959.7 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 20758.09 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 19959.7 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 20558.49 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 19959.7 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 19959.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 21356.88 } ] } ] }, { "description": "ANTI SS-B", "code_information": [ { "code": "86235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 182.5, "discounted_cash": 17.0, "minimum": 3.3696, "maximum": 3317.79, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 5.76, "10th_percentile": 3.43, "90th_percentile": 18.0, "count": "12" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 28.69, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 36.88, "10th_percentile": 36.88, "90th_percentile": 124.84, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.19, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 26.0, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.84, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 21.52, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 19.72, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.57, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.04, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 123.48, "10th_percentile": 123.48, "90th_percentile": 123.48, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.57, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.14 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.81, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANALYS GENE REARRANGE TRG", "code_information": [ { "code": "81342", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 874.6, "discounted_cash": 201.0, "minimum": 125.9424, "maximum": 857.108, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 164.3 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 161.17 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 201.5, "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": 322.4, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 156.48 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 159.61 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 207.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 207.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 292.18, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 215.61, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 211.58, "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": 282.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 292.18, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 156.48 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 301.65, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 241.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 161.17 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 221.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 298.62, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 156.48 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 292.6, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 156.48 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 201.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 201.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 164.3 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.47, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 201.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 215.61, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 181.35 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 301.24, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "Anes iper upr abd nos", "code_information": [ { "code": "00790", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3857.51, "minimum": 269.4596, "maximum": 3780.3598, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 282.93 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 277.54 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 269.46 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 274.85 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 269.46 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 277.54 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 269.46 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 269.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 282.93 } ] } ] }, { "description": "AMINO ACID PANEL QUANTITATIVE", "code_information": [ { "code": "82139", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 509.05, "discounted_cash": 16.0, "minimum": 15.18, "maximum": 498.869, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.6 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.11 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 26.99, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.87 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 24.38 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.11 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 18.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.0, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.5, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 371.4, "10th_percentile": 371.4, "90th_percentile": 371.4, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 25.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.53, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.18 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.22, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANTI THROMBIN", "code_information": [ { "code": "85300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 72.5, "discounted_cash": 11.0, "minimum": 10.44, "maximum": 275.282, "payers_information": [ { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.18, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.74, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.04, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.56, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 13.05 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.21, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 52.9, "10th_percentile": 52.9, "90th_percentile": 52.9, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.72, "additional_payer_notes": "149.50% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 8.36, "10th_percentile": 8.35, "90th_percentile": 10.44, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 18.96, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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" } ] } ] }, { "description": "ANALYSIS OF VOICE/RESONANCE", "code_information": [ { "code": "92524", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 562.72, "discounted_cash": 105.0, "minimum": 95.02, "maximum": 551.4656, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 99.77 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 97.87 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 169.12, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 95.02 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 96.92 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 113.1, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 483.94, "10th_percentile": 483.94, "90th_percentile": 483.94, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 95.02 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 158.23, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 126.84, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 97.87 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 116.27, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 156.65, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 95.02 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 153.49, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 95.02 }, { "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 Duals", "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": 99.77 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.59, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 158.02, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS - SOI : 2", "code_information": [ { "code": "1982", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4448.634, "maximum": 4760.04, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 4671.07 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4582.09 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4448.63 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 4626.58 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4448.63 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 4582.09 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4448.63 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 4448.63 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4760.04 } ] } ] }, { "description": "ANTI-RI ANTIBODIES", "code_information": [ { "code": "86256", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 182.4, "discounted_cash": 12.0, "minimum": 2.1427, "maximum": 494.9, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 19.28, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.89, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.86, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.5, "additional_payer_notes": "145.21% 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 Duals", "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": 11.81, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.85 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.01, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANCEF", "drug_information": { "unit": 1.0, "type": "GR" }, "code_information": [ { "code": "00409258501", "type": "NDC" }, { "code": "J0690", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 42.95, "10th_percentile": 21.47, "90th_percentile": 57.49, "count": "39" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 51.89, "10th_percentile": 25.95, "90th_percentile": 77.84, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 24.2, "10th_percentile": 24.2, "90th_percentile": 24.2, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 51.33, "10th_percentile": 25.66, "90th_percentile": 68.71, "count": "1 through 10" } ] } ] }, { "description": "Ankle arthroscopysurgery - 29895 - ", "code_information": [ { "code": "29895", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2451.54, "discounted_cash": 3080.0, "minimum": 735.462, "maximum": 2451.54, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2451.54 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2451.54 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2451.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 2451.54, "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": 2451.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2451.54 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2451.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2451.54 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 2451.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 2451.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2451.54, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2451.54, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 2451.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 2451.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2451.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2451.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2451.54, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2451.54 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2451.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2451.54, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2451.54, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2451.54 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2451.54, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2451.54, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2451.54 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2451.54, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2451.54 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2451.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2451.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 2451.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2451.54 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2451.54, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2451.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2451.54, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2451.54, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "AMPHETAMINES CONFIRMATION", "code_information": [ { "code": "80324", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 50.96, "minimum": 7.3382, "maximum": 372.4, "payers_information": [ { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 40.47 } ] } ] }, { "description": "ANTI-RIBONUCLEIC ACID AB", "code_information": [ { "code": "83520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 229.59, "discounted_cash": 17.0, "minimum": 7.5514, "maximum": 820.064, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "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": 27.63, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.04, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.48, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 18.13, "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": 24.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 25.04, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.85, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 19.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.59, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.08, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.92, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.48, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.54 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.82, "additional_payer_notes": "149.50% 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 Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "ANKLE BILATERAL (2 V) - 73600 - 3240012", "code_information": [ { "code": "73600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 639.67, "discounted_cash": 81.0, "minimum": 15.75, "maximum": 647.6232, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 385.64, "10th_percentile": 385.64, "90th_percentile": 385.64, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "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": 131.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 84.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 84.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 118.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 87.67, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 86.03, "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": 114.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 434.67, "10th_percentile": 434.67, "90th_percentile": 434.67, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 118.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 122.65, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 98.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 90.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 121.42, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 118.97, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80.29, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 87.67, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.75 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 122.49, "additional_payer_notes": "149.50% 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": 22909.0, "minimum": 9584.9, "maximum": 36655.088, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 20603.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 20603.6, "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": 36655.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 20603.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 21221.71, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 21221.71, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 33218.67, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22045.85, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 24054.9, "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": 29782.26, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 21221.71, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 20603.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 33218.67, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 20603.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 27743.32, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 27491.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 36655.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 22663.96, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 27466.12, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 26911.71, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22909.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20374.1 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 20603.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 34493.9 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 20603.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 20191.53, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 22909.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 24513.09, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 9613.37 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 27743.32, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ANTIBODY SCREEN (SCR)", "code_information": [ { "code": "86850", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 240.25, "discounted_cash": 49.0, "minimum": 8.79, "maximum": 235.445, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.28 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 34.6, "10th_percentile": 34.6, "90th_percentile": 34.6, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.53 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 78.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.41 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.16 }, { "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 Duals - My Care", "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": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 221.51, "10th_percentile": 221.51, "90th_percentile": 221.51, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 52.49, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 37.41 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 73.44, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 58.87, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.53 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 53.97, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 72.71, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 37.41 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 71.24, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.41 }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 219.11, "10th_percentile": 219.11, "90th_percentile": 219.11, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 49.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.28 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 48.08, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.79 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 73.34, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS - SOI : 3", "code_information": [ { "code": "1983", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6510.362, "maximum": 6966.09, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 6835.88 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 6705.67 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6510.36 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 6770.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6510.36 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 6705.67 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6510.36 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 6510.36 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6966.09 } ] } ] }, { "description": "ANKLE LEFT (2 V) - 73600 - 3220011", "code_information": [ { "code": "73600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 505.43, "discounted_cash": 81.0, "minimum": 15.75, "maximum": 647.6232, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 385.64, "10th_percentile": 385.64, "90th_percentile": 385.64, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "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": 131.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 84.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 84.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 118.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 87.67, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 86.03, "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": 114.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 434.67, "10th_percentile": 434.67, "90th_percentile": 434.67, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 118.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 122.65, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 98.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 90.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 121.42, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 118.97, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80.29, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 87.67, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.75 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 122.49, "additional_payer_notes": "149.50% 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": 34219.0, "minimum": 13392.6, "maximum": 56394.5, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 30746.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 30746.5, "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": 54750.45, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 30746.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 31668.9, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 31668.9, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 49617.59, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 32898.76, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 35929.98, "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": 44484.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 31668.9, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 30746.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 49617.59, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 30746.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 41439.25, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 41062.84, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 54750.45, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 33821.15, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 41025.2, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 40197.09, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 34219.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 56394.5 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 30746.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 51948.38 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 30746.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 30131.57, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 34219.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 36614.36, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 23026.61 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 41439.25, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ANTICHROMATIN", "code_information": [ { "code": "86235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23.4, "discounted_cash": 17.0, "minimum": 3.3696, "maximum": 3317.79, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 5.76, "10th_percentile": 3.43, "90th_percentile": 18.0, "count": "12" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 23.4, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": 23.4, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 36.88, "10th_percentile": 36.88, "90th_percentile": 124.84, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.19, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": 23.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 23.4, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 23.4, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 21.52, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 19.72, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 23.4, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 23.4 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 23.4, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 123.48, "10th_percentile": 123.48, "90th_percentile": 123.48, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.57, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.14 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.4, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANGIO-ARTERIO/VENOUS SHUNT(R)", "code_information": [ { "code": "75791", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 909.49, "discounted_cash": 762.0, "minimum": 272.847, "maximum": 909.49, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 762.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 762.55, "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": 909.49, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 762.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 785.43, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 785.43, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 909.49, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 815.93, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 800.68, "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": 909.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 762.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 762.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 909.49, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 762.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 909.49, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 909.49, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 838.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 909.49, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 909.49, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 762.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 762.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 762.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 747.3, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 762.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 815.93, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 909.49, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANKLE LEFT (MIN 3 V) - 73610 - 3220008", "code_information": [ { "code": "73610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 765.93, "discounted_cash": 81.0, "minimum": 17.97, "maximum": 764.0864, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 80.09 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 584.41, "10th_percentile": 584.4, "90th_percentile": 584.41, "count": "21" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.57 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "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": 131.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.81 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 84.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 84.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 118.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 706.19, "10th_percentile": 706.19, "90th_percentile": 706.19, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 87.67, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 86.03, "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": 114.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 229.78, "10th_percentile": 229.78, "90th_percentile": 454.77, "count": "23" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 658.7, "10th_percentile": 658.7, "90th_percentile": 658.7, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 118.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 122.65, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 98.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.57 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 90.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 121.42, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 118.97, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 698.53, "10th_percentile": 698.53, "90th_percentile": 698.53, "count": "37" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 80.09 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80.29, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 87.67, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.97 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 122.49, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB EXCEPT TOES - SOI : 2", "code_information": [ { "code": "3052", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12052.661, "maximum": 12896.35, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 12655.29 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 12414.24 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 12052.66 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 12534.77 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 12052.66 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 12414.24 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12052.66 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 12052.66 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12896.35 } ] } ] }, { "description": "ANTIMICROBIAL SUSCEPTIBILITY A", "code_information": [ { "code": "87181", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 317.44, "discounted_cash": 4.0, "minimum": 4.28, "maximum": 311.0912, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.48 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.03 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "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": 7.6, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.36 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.81 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 4.89, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 4.89, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "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": 6.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.36 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.11, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.03 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.04, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.36 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6.9, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.48 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.66, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.28 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.1, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANGIOGRAM THRU EXISTING CATH", "code_information": [ { "code": "75898", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1125.79, "discounted_cash": 2972.0, "minimum": 337.737, "maximum": 1125.79, "payers_information": [ { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1125.79, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1125.79, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 1125.79, "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": 1125.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1125.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1125.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1125.79, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 879.38 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1125.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1125.79, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1125.79, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 905.76 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1125.79, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1125.79, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 879.38 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1125.79, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 879.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1125.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1125.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 1125.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 923.35 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1125.79, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1125.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1125.79, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1125.79 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1125.79, "additional_payer_notes": "149.50% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 923.35 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 905.76 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1125.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 1125.79, "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": 1125.79, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 879.38 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1125.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 896.97 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 1125.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 1125.79, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANKLE RIGHT (2 V) - 73600 - 3220010", "code_information": [ { "code": "73600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 505.43, "discounted_cash": 81.0, "minimum": 15.75, "maximum": 647.6232, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 385.64, "10th_percentile": 385.64, "90th_percentile": 385.64, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "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": 131.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 84.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 84.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 118.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 87.67, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 86.03, "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": 114.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 434.67, "10th_percentile": 434.67, "90th_percentile": 434.67, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 118.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 122.65, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 98.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 90.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 121.42, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 118.97, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80.29, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 87.67, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.75 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 122.49, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "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": 15223.0, "minimum": 7484.1, "maximum": 25650.0, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13711.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 13711.0, "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": 24358.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13711.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 14122.33, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 14122.33, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 22074.6, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14670.77, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 15985.05, "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": 19791.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14122.33, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 13711.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22074.6, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 13711.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18436.09, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 18268.63, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 24358.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 15082.1, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18251.89, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17883.47, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15223.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14861.2 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 13711.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 22632.5 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 13711.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13436.78, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 15223.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 16289.53, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 9909.31 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18436.09, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ANTIMYELOPEROXIDASE (MPO) AB", "code_information": [ { "code": "83520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 52.44, "discounted_cash": 17.0, "minimum": 7.5514, "maximum": 820.064, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 17.28, "10th_percentile": 17.28, "90th_percentile": 25.72, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "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": 27.63, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.04, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 129.08, "10th_percentile": 129.08, "90th_percentile": 129.08, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.48, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 18.13, "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": 24.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 59.56, "10th_percentile": 59.56, "90th_percentile": 185.76, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 25.04, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.85, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 19.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.59, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.08, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 82.08, "10th_percentile": 82.08, "90th_percentile": 82.08, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.92, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.48, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.54 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.82, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANKLE RIGHT (MIN 3 V)", "code_information": [ { "code": "73610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 765.93, "discounted_cash": 81.0, "minimum": 17.97, "maximum": 764.0864, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 584.41, "10th_percentile": 584.4, "90th_percentile": 584.41, "count": "21" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "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": 131.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 84.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 84.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 118.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 706.19, "10th_percentile": 706.19, "90th_percentile": 706.19, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 87.67, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 86.03, "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": 114.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 229.78, "10th_percentile": 229.78, "90th_percentile": 454.77, "count": "23" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 658.7, "10th_percentile": 658.7, "90th_percentile": 658.7, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 118.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 122.65, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 98.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 90.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 121.42, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 118.97, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 698.53, "10th_percentile": 698.53, "90th_percentile": 698.53, "count": "37" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80.29, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 87.67, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.97 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 122.49, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANKLE RIGHT (MIN 3 V)", "code_information": [ { "code": "73610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 765.93, "discounted_cash": 81.0, "minimum": 17.97, "maximum": 764.0864, "payers_information": [ { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 84.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 84.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 118.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 706.19, "10th_percentile": 706.19, "90th_percentile": 706.19, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 87.67, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 86.03, "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": 114.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 229.78, "10th_percentile": 229.78, "90th_percentile": 454.77, "count": "23" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 658.7, "10th_percentile": 658.7, "90th_percentile": 658.7, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 118.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 122.65, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 98.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 90.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 121.42, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 118.97, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 698.53, "10th_percentile": 698.53, "90th_percentile": 698.53, "count": "37" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80.29, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 87.67, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.97 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 122.49, "additional_payer_notes": "149.50% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 584.41, "10th_percentile": 584.4, "90th_percentile": 584.41, "count": "21" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "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": 131.09, "additional_payer_notes": "160.00% 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": 11679.0, "minimum": 5514.6, "maximum": 18900.0, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10532.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 10532.5, "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": 18687.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10532.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 10848.48, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 10848.48, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 16935.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11269.78, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 12263.8, "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": 15183.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10848.48, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 10532.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16935.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 10532.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14144.25, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 14015.77, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 18687.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 11585.75, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14002.92, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 13720.27, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11679.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13512.0 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 10532.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 17162.85 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 10532.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10321.85, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 11679.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 12497.4, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 8727.83 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14144.25, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ANTINUCLEAR ANTIBODIES - 86038 - 3021230", "code_information": [ { "code": "86038", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26.1, "discounted_cash": 12.0, "minimum": 1.7568, "maximum": 509.6, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 2.04, "10th_percentile": 1.41, "90th_percentile": 2.04, "count": "68" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 19.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 13.0, "10th_percentile": 13.0, "90th_percentile": 13.0, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.94, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 12.13, "10th_percentile": 8.39, "90th_percentile": 12.13, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.53, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.51, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.3, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 26.1 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.56, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 12.86, "10th_percentile": 12.86, "90th_percentile": 12.86, "count": "21" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.88 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.07, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "Ankle arthroscopysurgery - 29898 - ", "code_information": [ { "code": "29898", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2647.6, "discounted_cash": 3080.0, "minimum": 794.28, "maximum": 2647.6, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2647.6 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2647.6 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2647.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 2647.6, "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": 2647.6, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2647.6 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2647.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2647.6 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 2647.6, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 2647.6, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2647.6, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2647.6, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 2647.6, "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": 2647.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2647.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2647.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2647.6, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2647.6 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2647.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2647.6, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2647.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2647.6 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2647.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2647.6, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2460.11 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2647.6, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2647.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2647.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2647.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 2647.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2647.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2647.6, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2647.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2647.6, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2647.6, "additional_payer_notes": "149.50% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 2647.6, "discounted_cash": 3080.0, "minimum": 794.28, "maximum": 2647.6, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2647.6 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2647.6 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2647.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 2647.6, "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": 2647.6, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2647.6 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2647.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2647.6 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 2647.6, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 2647.6, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2647.6, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2647.6, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 2647.6, "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": 2647.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2647.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2647.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2647.6, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2647.6 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2647.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2647.6, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2647.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2647.6 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2647.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2647.6, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2460.11 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2647.6, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2647.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2647.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2647.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 2647.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2647.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2647.6, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2647.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2647.6, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2647.6, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANLYZE 100-300 CELLS", "code_information": [ { "code": "88275", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1152.0, "discounted_cash": 51.0, "minimum": 23.6304, "maximum": 1128.96, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 118.4 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 116.14 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 51.19, "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": 81.9, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.76 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 115.02 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 52.73, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 52.73, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 74.23, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 54.77, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 53.75, "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": 71.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 74.23, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.76 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 76.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 61.43, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 116.14 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 56.31, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 75.86, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 112.76 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 74.33, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.76 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 51.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 51.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 118.4 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.17, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 51.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 54.77, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.07 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 76.53, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANA DIRECT", "code_information": [ { "code": "86038", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12.2, "discounted_cash": 12.0, "minimum": 1.7568, "maximum": 509.6, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 1.76, "10th_percentile": 1.76, "90th_percentile": 1.76, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 12.2, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 12.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.2, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.2, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 12.2, "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": 12.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.2, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 12.2, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.2, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 12.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 12.2, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 12.2 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 12.2, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 20.33, "10th_percentile": 20.33, "90th_percentile": 20.33, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": 12.2, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.88 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.2, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANTISKIN AB QUANT LC", "code_information": [ { "code": "86255", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 101.8, "discounted_cash": 12.0, "minimum": 3.0528, "maximum": 1274.0, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 3.06, "10th_percentile": 3.06, "90th_percentile": 3.06, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 19.28, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.89, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.86, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.5, "additional_payer_notes": "145.21% 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 Duals", "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": 11.81, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.85 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.01, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANKLE BILATERAL (MIN 3 V) - 73610 - 3220009", "code_information": [ { "code": "73610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 779.68, "discounted_cash": 81.0, "minimum": 17.97, "maximum": 764.0864, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 584.41, "10th_percentile": 584.4, "90th_percentile": 584.41, "count": "21" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "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": 131.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 84.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 84.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 118.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 706.19, "10th_percentile": 706.19, "90th_percentile": 706.19, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 87.67, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 86.03, "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": 114.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 229.78, "10th_percentile": 229.78, "90th_percentile": 454.77, "count": "23" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 658.7, "10th_percentile": 658.7, "90th_percentile": 658.7, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 118.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 122.65, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 98.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 90.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 121.42, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 118.97, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 698.53, "10th_percentile": 698.53, "90th_percentile": 698.53, "count": "37" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80.29, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 87.67, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.97 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 122.49, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANTEPARTUM WITH O.R. PROCEDURE- SOI : 2", "code_information": [ { "code": "5472", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7231.472, "maximum": 7737.68, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 7593.05 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7448.42 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7231.47 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 7520.73 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7231.47 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 7448.42 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7231.47 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 7231.47 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7737.68 } ] } ] }, { "description": "ANA, RFLX TO 11 BIOMARKER PROF", "code_information": [ { "code": "86038", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14.1, "discounted_cash": 12.0, "minimum": 1.7568, "maximum": 509.6, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 2.04, "10th_percentile": 1.41, "90th_percentile": 2.04, "count": "68" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 14.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": 14.1, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 13.0, "10th_percentile": 13.0, "90th_percentile": 13.0, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.94, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": 14.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 12.13, "10th_percentile": 8.39, "90th_percentile": 12.13, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.1, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.1, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.3, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.1, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 14.1 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.1, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 12.86, "10th_percentile": 12.86, "90th_percentile": 12.86, "count": "21" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.88 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.1, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "APICAL LORDOTIC VIEW - 71045 - 3220013", "code_information": [ { "code": "71045", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 311.5, "discounted_cash": 81.0, "minimum": 11.07, "maximum": 427.378, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 80.09 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 79.9, "10th_percentile": 8.11, "90th_percentile": 332.75, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.57 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "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": 131.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.81 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 84.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 84.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 118.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 402.08, "10th_percentile": 402.08, "90th_percentile": 402.08, "count": "24" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 87.67, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 86.03, "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": 114.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 131.92, "10th_percentile": 131.92, "90th_percentile": 131.92, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 8.11, "10th_percentile": 8.11, "90th_percentile": 8.11, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 375.05, "10th_percentile": 174.44, "90th_percentile": 375.05, "count": "69" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 118.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 122.65, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 98.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.57 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 90.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 121.42, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 118.97, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 397.72, "10th_percentile": 397.72, "90th_percentile": 397.72, "count": "102" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 80.09 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80.29, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 87.67, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.07 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 122.49, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANKLE LEFT (MIN 3 V) - 73610 - 3240008", "code_information": [ { "code": "73610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 765.93, "discounted_cash": 81.0, "minimum": 17.97, "maximum": 764.0864, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 584.41, "10th_percentile": 584.4, "90th_percentile": 584.41, "count": "21" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "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": 131.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 84.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 84.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 118.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 706.19, "10th_percentile": 706.19, "90th_percentile": 706.19, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 87.67, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 86.03, "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": 114.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 229.78, "10th_percentile": 229.78, "90th_percentile": 454.77, "count": "23" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 658.7, "10th_percentile": 658.7, "90th_percentile": 658.7, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 118.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 122.65, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 98.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 90.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 121.42, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 118.97, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 698.53, "10th_percentile": 698.53, "90th_percentile": 698.53, "count": "37" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80.29, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 87.67, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.97 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 122.49, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANTEPARTUM WITH O.R. PROCEDURE- SOI : 4", "code_information": [ { "code": "5474", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 19226.0, "maximum": 20571.82, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 20187.3 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 19802.78 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 19226.0 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 19995.04 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 19226.0 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 19802.78 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 19226.0 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 19226.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 20571.82 } ] } ] }, { "description": "ANAEROBIC CULTURE", "code_information": [ { "code": "87075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 270.0, "discounted_cash": 9.0, "minimum": 8.52, "maximum": 264.6, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.48 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 38.88, "10th_percentile": 38.88, "90th_percentile": 38.88, "count": "48" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.03 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "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": 15.15, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.36 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.81 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 9.75, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 9.75, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 248.94, "10th_percentile": 248.94, "90th_percentile": 248.94, "count": "14" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 9.94, "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": 13.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 253.2, "10th_percentile": 129.45, "90th_percentile": 425.98, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 232.2, "10th_percentile": 232.2, "90th_percentile": 232.2, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.36 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 11.36, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.03 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 10.42, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.03, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.36 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 13.75, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 246.24, "10th_percentile": 246.24, "90th_percentile": 246.24, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.48 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.28, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.52 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.16, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "APOLIPIPROTEIN A-1", "code_information": [ { "code": "82172", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 114.47, "discounted_cash": 21.0, "minimum": 3.456, "maximum": 209.3378, "payers_information": [ { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 30.62, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 114.0, "10th_percentile": 114.0, "90th_percentile": 114.0, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.53, "additional_payer_notes": "149.50% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 18.0, "10th_percentile": 16.49, "90th_percentile": 25.72, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 33.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 22.13, "10th_percentile": 22.13, "90th_percentile": 22.13, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 22.57, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 30.58, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.57, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 25.31, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 23.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.26, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.38 } ] } ] }, { "description": "ANOXIC & OTHER SEVERE BRAIN DAMAGE - SOI : 2", "code_information": [ { "code": "0592", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11843.161, "maximum": 12672.18, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 12435.32 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 12198.46 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 11843.16 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 12316.89 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 11843.16 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 12198.46 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11843.16 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 11843.16 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12672.18 } ] } ] }, { "description": "ANTEPARTUM WITHOUT O.R. PROCEDURE- SOI : 2", "code_information": [ { "code": "5662", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3900.159, "maximum": 4173.17, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 4095.17 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4017.16 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3900.16 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 4056.17 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3900.16 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 4017.16 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3900.16 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 3900.16 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4173.17 } ] } ] }, { "description": "ANAEROBIC SUSCEPTIBILITY", "code_information": [ { "code": "87186", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 38.0, "discounted_cash": 8.0, "minimum": 3.7382, "maximum": 956.088, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 26.13, "10th_percentile": 26.13, "90th_percentile": 52.26, "count": "81" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 13.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 167.3, "10th_percentile": 167.3, "90th_percentile": 334.59, "count": "19" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.26, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 156.05, "10th_percentile": 156.05, "90th_percentile": 156.05, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 156.05, "10th_percentile": 145.44, "90th_percentile": 156.05, "count": "26" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 9.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 12.82, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.36 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 12.56, "additional_payer_notes": "145.21% 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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 165.48, "10th_percentile": 165.48, "90th_percentile": 165.48, "count": "32" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.48, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.79 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.93, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "APOLOPOPROTEIN B", "code_information": [ { "code": "82172", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26.88, "discounted_cash": 21.0, "minimum": 3.456, "maximum": 209.3378, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 3.88, "10th_percentile": 3.88, "90th_percentile": 3.88, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 26.88, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": 26.88, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 24.78, "10th_percentile": 24.78, "90th_percentile": 24.78, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 22.57, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": 26.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 25.31, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 23.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANOXIC & OTHER SEVERE BRAIN DAMAGE - SOI : 4", "code_information": [ { "code": "0594", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17322.52, "maximum": 18535.1, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 18188.65 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 17842.2 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 17322.52 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 18015.42 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 17322.52 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 17842.2 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 17322.52 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 17322.52 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 18535.1 } ] } ] }, { "description": "ANTEPARTUM WITHOUT O.R. PROCEDURE- SOI : 3", "code_information": [ { "code": "5663", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4793.005, "maximum": 5128.52, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 5032.66 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4936.8 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4793.01 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 4984.73 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4793.01 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 4936.8 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4793.01 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 4793.01 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5128.52 } ] } ] }, { "description": "ANAL AND PERINEAL PROCEDURES- SOI : 4", "code_information": [ { "code": "2264", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15865.914, "maximum": 16976.53, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 16659.21 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 16341.89 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 15865.91 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 16500.55 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 15865.91 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 16341.89 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15865.91 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 15865.91 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 16976.53 } ] } ] }, { "description": "APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS - SOI : 4", "code_information": [ { "code": "2334", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 19485.851, "maximum": 20849.86, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 20460.14 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 20070.43 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 19485.85 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 20265.29 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 19485.85 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 20070.43 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 19485.85 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 19485.85 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 20849.86 } ] } ] }, { "description": "ANTI HBC Igm", "code_information": [ { "code": "86705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14.0, "discounted_cash": 11.0, "minimum": 2.016, "maximum": 14.0, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 2.04, "10th_percentile": 2.04, "90th_percentile": 2.04, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 11.77, "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": 14.0, "additional_payer_notes": "160.00% 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": 11.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.0, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.59, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 12.36, "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": 14.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.0, "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": 11.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.0, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.0, "additional_payer_notes": "145.21% 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": 11.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 11.77, "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": 11.53, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.59, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.59 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.0, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANTI STREPTO", "code_information": [ { "code": "86060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18.35, "discounted_cash": 7.0, "minimum": 2.6424, "maximum": 18.35, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.35 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 2.12, "10th_percentile": 2.12, "90th_percentile": 2.12, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.35 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 11.68, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.35 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.35 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 18.35 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 10.93, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.35 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 18.35 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 10.6, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.35 }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 13.39, "10th_percentile": 13.39, "90th_percentile": 16.74, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 18.35 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.15, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.91, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITH CC", "code_information": [ { "code": "348", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10821.0, "minimum": 4070.3, "maximum": 17313.984, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9762.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 9762.53, "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": 17313.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9762.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 10055.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 10055.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 15690.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10445.91, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 11362.3, "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": 14067.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10055.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 9762.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15690.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 9762.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 13104.52, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 12985.49, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 17313.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 10738.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12973.58, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12711.71, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10821.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13137.6 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 9762.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 15837.79 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 9762.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9567.28, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 10821.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 11578.73, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 9457.34 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13104.52, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS - SOI : 2", "code_information": [ { "code": "2342", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8266.382, "maximum": 8845.03, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 8679.7 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 8514.37 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 8266.38 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 8597.04 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 8266.38 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 8514.37 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8266.38 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 8266.38 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8845.03 } ] } ] }, { "description": "ANTI MITOCHONDRIAL AB", "code_information": [ { "code": "86381", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 29.75, "discounted_cash": 25.0, "minimum": 4.284, "maximum": 124.705, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.75 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 4.29, "10th_percentile": 4.28, "90th_percentile": 4.29, "count": "13" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.75 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 29.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.75 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.75 }, { "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 Duals - My Care", "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": 29.75, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 27.23, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": 29.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 25.59, "10th_percentile": 25.59, "90th_percentile": 25.59, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 29.75 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 29.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 29.75, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.75 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 28.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 29.75, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 29.75 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 29.75, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.75 }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 27.13, "10th_percentile": 27.13, "90th_percentile": 27.13, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 29.75 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.94, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.91 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.75, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANTI THROMBIN ACTIVITY", "code_information": [ { "code": "85300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 280.9, "discounted_cash": 11.0, "minimum": 10.44, "maximum": 275.282, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.7 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 8.36, "10th_percentile": 8.35, "90th_percentile": 10.44, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 18.96, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.05 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.31 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.74, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.04, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.56, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 13.05 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.21, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.05 }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 52.9, "10th_percentile": 52.9, "90th_percentile": 52.9, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 13.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.72, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITH MCC", "code_information": [ { "code": "347", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18558.0, "minimum": 7352.8, "maximum": 29693.696, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16701.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 16701.6, "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": 29693.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16701.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 17202.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 17202.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 26909.91, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17870.71, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 19486.49, "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": 24126.13, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17202.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 16701.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 26909.91, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 16701.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 22474.42, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 22270.27, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 29693.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 18371.76, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 22249.86, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21800.74, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18558.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25683.7 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 16701.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 27779.06 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 16701.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16367.57, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 18558.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 19857.66, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 16706.83 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 22474.42, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS - SOI : 3", "code_information": [ { "code": "2343", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15251.801, "maximum": 16319.43, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 16014.39 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 15709.36 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 15251.8 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 15861.87 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 15251.8 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 15709.36 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15251.8 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 15251.8 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 16319.43 } ] } ] }, { "description": "ANTI SS-A", "code_information": [ { "code": "86235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 182.5, "discounted_cash": 17.0, "minimum": 3.3696, "maximum": 3317.79, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 5.76, "10th_percentile": 3.43, "90th_percentile": 18.0, "count": "12" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 28.69, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 36.88, "10th_percentile": 36.88, "90th_percentile": 124.84, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.19, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 26.0, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.84, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 21.52, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 19.72, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.57, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.04, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 123.48, "10th_percentile": 123.48, "90th_percentile": 123.48, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.57, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.14 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.81, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANTI-A4-FLA2 IGG, ELSIA", "code_information": [ { "code": "83520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 56.26, "discounted_cash": 17.0, "minimum": 7.5514, "maximum": 820.064, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 17.28, "10th_percentile": 17.28, "90th_percentile": 25.72, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "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": 27.63, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.04, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 129.08, "10th_percentile": 129.08, "90th_percentile": 129.08, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.48, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 18.13, "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": 24.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 59.56, "10th_percentile": 59.56, "90th_percentile": 185.76, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 25.04, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.85, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 19.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.59, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.08, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 82.08, "10th_percentile": 82.08, "90th_percentile": 82.08, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.92, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.48, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.54 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.82, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANCA SCREEN EACH ANTIBODY LC5", "code_information": [ { "code": "86036", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 520.0, "discounted_cash": 12.0, "minimum": 10.85, "maximum": 509.6, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.56 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.94 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 19.28, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.63 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.89, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 31.01 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.94 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.86, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.5, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "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 Duals", "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": 32.56 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.81, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.85 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.01, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "APPLICATION OF UNNA BOOT", "code_information": [ { "code": "29580", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 728.8, "discounted_cash": 152.0, "minimum": 141.44, "maximum": 714.224, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.51 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 145.68 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 244.77, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 141.44 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 144.27 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 163.69, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 141.44 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 183.58, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 145.68 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 168.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 226.72, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 141.44 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 222.14, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 141.44 }, { "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 Duals", "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": 148.51 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 149.92, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 228.71, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANTI-CB1RL IGG", "code_information": [ { "code": "83520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 56.26, "discounted_cash": 17.0, "minimum": 7.5514, "maximum": 820.064, "payers_information": [ { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 25.04, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.85, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 19.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.59, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.08, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 82.08, "10th_percentile": 82.08, "90th_percentile": 82.08, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.92, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.48, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.54 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.82, "additional_payer_notes": "149.50% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 17.28, "10th_percentile": 17.28, "90th_percentile": 25.72, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "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": 27.63, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.04, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 129.08, "10th_percentile": 129.08, "90th_percentile": 129.08, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.48, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 18.13, "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": 24.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 59.56, "10th_percentile": 59.56, "90th_percentile": 185.76, "count": "1 through 10" } ] } ] }, { "description": "ANTI-FLAX IGG, ELSIA", "code_information": [ { "code": "83520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 56.26, "discounted_cash": 17.0, "minimum": 7.5514, "maximum": 820.064, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 17.28, "10th_percentile": 17.28, "90th_percentile": 25.72, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "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": 27.63, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.04, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 129.08, "10th_percentile": 129.08, "90th_percentile": 129.08, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.48, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 18.13, "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": 24.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 59.56, "10th_percentile": 59.56, "90th_percentile": 185.76, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 25.04, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.85, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 19.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.59, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.08, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 82.08, "10th_percentile": 82.08, "90th_percentile": 82.08, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.92, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.48, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.54 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.82, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANCHORAGE FIXATION PIN", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "APPLY SHIRT ARM SPLINT/DYNAMIC", "code_information": [ { "code": "29126", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 532.4, "discounted_cash": 125.0, "minimum": 75.86, "maximum": 532.4, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 79.65 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.14 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 200.4, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.86 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.38 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 134.02, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 75.86 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 150.3, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.14 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 137.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 185.62, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 75.86 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 181.88, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.86 }, { "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 Duals", "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": 79.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 122.75, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 187.25, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANTI-HU ANTIBODIES", "code_information": [ { "code": "86256", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 182.4, "discounted_cash": 12.0, "minimum": 2.1427, "maximum": 494.9, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 19.28, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.89, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.86, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.5, "additional_payer_notes": "145.21% 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 Duals", "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": 11.81, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.85 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.01, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANTI-SRP AB RDL LC", "code_information": [ { "code": "83516", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 156.8, "discounted_cash": 11.0, "minimum": 3.8088, "maximum": 641.655, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 17.34, "10th_percentile": 12.11, "90th_percentile": 17.34, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 18.45, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.34, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.26, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.09, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.74, "additional_payer_notes": "145.21% 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 Duals", "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": 11.3, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.38 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.24, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANGINA PECTORIS", "code_information": [ { "code": "311", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6062.0, "minimum": 2626.0, "maximum": 9700.224, "payers_information": [ { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 5494.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8790.83, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 5494.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7341.86, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 7275.17, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 9700.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 6044.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7268.5, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7121.78, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6062.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6454.42 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 5494.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 8493.69 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 5494.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5384.97, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 6062.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 6487.02, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4131.72 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7341.86, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 5494.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 5494.87, "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": 9700.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5494.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 5659.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 5659.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 8790.83, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5879.51, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 6365.77, "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": 7881.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5659.72, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "APTTMX60", "code_information": [ { "code": "85732", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 133.33, "discounted_cash": 6.0, "minimum": 5.82, "maximum": 130.6634, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.7 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 43.98, "10th_percentile": 43.98, "90th_percentile": 43.98, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 10.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.05 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.31 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.92, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 13.05 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9.69, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 7.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 7.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9.59, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 13.05 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9.4, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.05 }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.34, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.82 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.67, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANTI-OMPC IGA, ELSIA", "code_information": [ { "code": "83520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 56.26, "discounted_cash": 17.0, "minimum": 7.5514, "maximum": 820.064, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 17.28, "10th_percentile": 17.28, "90th_percentile": 25.72, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "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": 27.63, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.04, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 129.08, "10th_percentile": 129.08, "90th_percentile": 129.08, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.48, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 18.13, "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": 24.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 59.56, "10th_percentile": 59.56, "90th_percentile": 185.76, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 25.04, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.85, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 19.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.59, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.08, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 82.08, "10th_percentile": 82.08, "90th_percentile": 82.08, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.92, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.48, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.54 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.82, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANTIBODY ID", "code_information": [ { "code": "86870", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 628.26, "discounted_cash": 337.0, "minimum": 22.58, "maximum": 615.6948, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.7 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 90.47, "10th_percentile": 90.47, "90th_percentile": 90.47, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 72.3 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 539.92, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.19 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 337.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 71.59 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 361.07, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 337.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 337.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 70.19 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 505.16, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 404.94, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 72.3 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 371.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 500.1, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 70.19 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 490.01, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.19 }, { "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 Duals", "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": 73.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 330.7, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.58 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 504.49, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS - SOI : 4", "code_information": [ { "code": "1984", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13079.479, "maximum": 13995.04, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 13733.45 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 13471.86 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 13079.48 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 13602.66 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 13079.48 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 13471.86 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13079.48 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 13079.48 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 13995.04 } ] } ] }, { "description": "APTTMXP", "code_information": [ { "code": "85732", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 133.33, "discounted_cash": 6.0, "minimum": 5.82, "maximum": 130.6634, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 43.98, "10th_percentile": 43.98, "90th_percentile": 43.98, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 10.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.92, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9.69, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 7.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 7.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9.59, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 13.05 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9.4, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.34, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.82 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.67, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANTI-PLA2R - 83516 - 3007575", "code_information": [ { "code": "83516", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 250.0, "discounted_cash": 11.0, "minimum": 3.8088, "maximum": 641.655, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 17.34, "10th_percentile": 12.11, "90th_percentile": 17.34, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 18.45, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.34, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.26, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.09, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.74, "additional_payer_notes": "145.21% 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 Duals", "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": 11.3, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.38 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.24, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANTIEXTRACTABLE NUCLEAR AG", "code_information": [ { "code": "86235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 47.7, "discounted_cash": 17.0, "minimum": 3.3696, "maximum": 3317.79, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 23.74, "10th_percentile": 6.87, "90th_percentile": 23.74, "count": "29" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 28.69, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 43.98, "10th_percentile": 30.4, "90th_percentile": 121.59, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.19, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 141.77, "10th_percentile": 141.77, "90th_percentile": 141.77, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 26.0, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.84, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 21.52, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 19.72, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.57, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.04, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 150.34, "10th_percentile": 35.64, "90th_percentile": 150.34, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.57, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.14 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.81, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "AQUATIC THERAPY - 15 MIN", "code_information": [ { "code": "97113", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 198.0, "discounted_cash": 35.0, "minimum": 18.231, "maximum": 194.04, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 120.0 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 302.15, "10th_percentile": 151.08, "90th_percentile": 453.23, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 117.72 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 35.28, "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": 56.45, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 114.29 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 116.58 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 36.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 36.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 51.16, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 365.11, "10th_percentile": 365.11, "90th_percentile": 547.67, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.75, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 37.04, "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": 49.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 452.25, "10th_percentile": 452.25, "90th_percentile": 452.25, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 51.16, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 114.29 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 42.34, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 117.72 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 38.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.28, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 114.29 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 51.23, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 114.29 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 541.73, "10th_percentile": 361.15, "90th_percentile": 722.31, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 35.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 120.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.57, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 35.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 37.75, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.74, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANTI-PLA2R - 83516 - 3007875", "code_information": [ { "code": "83516", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 525.0, "discounted_cash": 11.0, "minimum": 3.8088, "maximum": 641.655, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 17.34, "10th_percentile": 12.11, "90th_percentile": 17.34, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 18.45, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.34, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.26, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.09, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.74, "additional_payer_notes": "145.21% 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 Duals", "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": 11.3, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.38 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.24, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANTIPHOSPHATIDYLSERINE IgG/M/A", "code_information": [ { "code": "86148", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 97.75, "discounted_cash": 16.0, "minimum": 14.076, "maximum": 95.795, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.56 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 11.26, "10th_percentile": 11.26, "90th_percentile": 11.26, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.94 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 25.71, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.63 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 31.01 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.06, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 19.28, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.94 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 17.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 23.82, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 23.34, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "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 Duals", "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": 32.56 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.75, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.02, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANKLE BILATERAL (2 V) - 73600 - 3220012", "code_information": [ { "code": "73600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 660.84, "discounted_cash": 81.0, "minimum": 15.75, "maximum": 647.6232, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 385.64, "10th_percentile": 385.64, "90th_percentile": 385.64, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "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": 131.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 84.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 84.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 118.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 87.67, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 86.03, "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": 114.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 434.67, "10th_percentile": 434.67, "90th_percentile": 434.67, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 118.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 122.65, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 98.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 90.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 121.42, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 118.97, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80.29, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 87.67, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.75 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 122.49, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ARTERIOGRAM-MESENTERIC", "code_information": [ { "code": "75726", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5066.48, "discounted_cash": 5238.0, "minimum": 49.71, "maximum": 5066.48, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4034.86 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3958.0 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5066.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 5066.48, "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": 5066.48, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3842.72 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5066.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3919.57 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 5066.48, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 5066.48, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5066.48, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5066.48, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 5066.48, "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": 5066.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5066.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5066.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5066.48, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3842.72 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5066.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5066.48, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 5066.48, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3958.0 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5066.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5066.48, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3842.72 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5066.48, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3842.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5066.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5066.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 5066.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4034.86 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5066.48, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5066.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5066.48, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.71 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5066.48, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANTIDIURETIC HORMONE", "code_information": [ { "code": "84588", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 97.76, "discounted_cash": 33.0, "minimum": 14.0774, "maximum": 95.8048, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.06 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.32 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 54.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.2 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.94 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 34.96, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 34.96, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 49.21, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 36.32, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 35.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 47.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 49.21, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.2 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 50.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 40.73, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.32 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 37.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 50.3, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 37.2 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 49.28, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.06 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.26, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 36.32, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.55 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50.74, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANTISCLERODERMA-70 ANTIBODIES", "code_information": [ { "code": "86235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40.0, "discounted_cash": 17.0, "minimum": 3.3696, "maximum": 3317.79, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 5.76, "10th_percentile": 3.43, "90th_percentile": 18.0, "count": "12" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 28.69, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 36.88, "10th_percentile": 36.88, "90th_percentile": 124.84, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.19, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 26.0, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.84, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 21.52, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 19.72, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.57, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.04, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 123.48, "10th_percentile": 123.48, "90th_percentile": 123.48, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.57, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.14 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.81, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANKLE LEFT (2 V) - 73600 - 3240011", "code_information": [ { "code": "73600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 348.06, "discounted_cash": 81.0, "minimum": 15.75, "maximum": 647.6232, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80.29, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 87.67, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.75 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 122.49, "additional_payer_notes": "149.50% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 385.64, "10th_percentile": 385.64, "90th_percentile": 385.64, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "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": 131.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 84.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 84.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 118.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 87.67, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 86.03, "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": 114.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 434.67, "10th_percentile": 434.67, "90th_percentile": 434.67, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 118.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 122.65, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 98.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 90.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 121.42, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 118.97, "additional_payer_notes": "145.21% of Medicare Rates" } ] } ] }, { "description": "ARTHROCENT ASPIR-INJ JT MAJOR - 20610 - 3612758", "code_information": [ { "code": "20610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1237.4, "discounted_cash": 288.0, "minimum": 283.1906, "maximum": 2790.05, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 462.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 288.97, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 309.2, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 288.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 288.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 432.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 346.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 317.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 428.25, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1237.4 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 419.61, "additional_payer_notes": "145.21% 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 Duals", "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": 283.19, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 432.01, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANTIGEN ID", "code_information": [ { "code": "86905", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 143.28, "discounted_cash": 337.0, "minimum": 3.45, "maximum": 143.28, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.28 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 41.27, "10th_percentile": 41.27, "90th_percentile": 41.27, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.53 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 143.28, "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": 143.28, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.41 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.16 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 143.28, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 143.28, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 143.28, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 143.28, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 143.28, "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": 143.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 143.28, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.41 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 143.28, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 143.28, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.53 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 143.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 143.28, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 37.41 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 143.28, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 143.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 143.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.28 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.28, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 143.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 143.28, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.45 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 143.28, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANTITHROMBIN III ANTIGEN", "code_information": [ { "code": "85301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 32.6, "discounted_cash": 10.0, "minimum": 4.6944, "maximum": 31.948, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.7 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 17.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.05 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.31 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.97, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 11.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.02, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 13.05 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.7, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.05 }, { "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 Duals", "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": 13.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.59, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.16, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANKLE RIGHT (2 V) - 73600 - 3240010", "code_information": [ { "code": "73600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 311.5, "discounted_cash": 81.0, "minimum": 15.75, "maximum": 647.6232, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 80.09 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 385.64, "10th_percentile": 385.64, "90th_percentile": 385.64, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.57 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "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": 131.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.81 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 84.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 84.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 118.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 87.67, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 86.03, "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": 114.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 434.67, "10th_percentile": 434.67, "90th_percentile": 434.67, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 118.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 122.65, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 98.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.57 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 90.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 121.42, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 118.97, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 80.09 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80.29, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 87.67, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.75 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 122.49, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ARTHROCENT ASPIR-INJ JT MAJOR - 20610 - 3612759", "code_information": [ { "code": "20610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1237.4, "discounted_cash": 288.0, "minimum": 283.1906, "maximum": 2790.05, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 462.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 288.97, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 309.2, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 288.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 288.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 432.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 346.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 317.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 428.25, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1237.4 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 419.61, "additional_payer_notes": "145.21% 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 Duals", "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": 283.19, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 432.01, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANTIGLOMERULAR BASEMENT MEMBRN", "code_information": [ { "code": "83516", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 29.32, "discounted_cash": 11.0, "minimum": 3.8088, "maximum": 641.655, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 17.34, "10th_percentile": 12.11, "90th_percentile": 17.34, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 18.45, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.34, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.26, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.09, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.74, "additional_payer_notes": "145.21% 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 Duals", "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": 11.3, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.38 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.24, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "APHERESIS PLATELETS", "code_information": [ { "code": "P9035", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2431.5, "discounted_cash": 509.0, "minimum": 460.7177, "maximum": 2382.87, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 483.76 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 474.54 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 509.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 509.08, "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": 814.53, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 460.72 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 509.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 469.93 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 524.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 524.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 738.17, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 544.72, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 534.53, "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": 712.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 509.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 509.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 738.17, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 460.72 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 509.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 762.09, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 610.9, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 474.54 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 559.99, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 754.46, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 460.72 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 739.24, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 460.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 509.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 509.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 509.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 483.76 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 498.9, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 509.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 544.72, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 761.07, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANOXIC & OTHER SEVERE BRAIN DAMAGE - SOI : 1", "code_information": [ { "code": "0591", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11843.161, "maximum": 12672.18, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 12435.32 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 12198.46 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 11843.16 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 12316.89 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 11843.16 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 12198.46 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11843.16 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 11843.16 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12672.18 } ] } ] }, { "description": "ARTHROGRAM ELBOW RIGHT - 73085 - 3240024", "code_information": [ { "code": "73085", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1929.4, "discounted_cash": 328.0, "minimum": 47.5, "maximum": 1890.812, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 525.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 351.43, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 476.24, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 491.67, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 394.13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 361.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 486.75, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 476.93, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 321.87, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.5 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 491.02, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANTINUCLEAR ANTIBODIES - 86038 - 3001180", "code_information": [ { "code": "86038", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14.1, "discounted_cash": 12.0, "minimum": 1.7568, "maximum": 509.6, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.1 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 2.04, "10th_percentile": 1.41, "90th_percentile": 2.04, "count": "68" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.1 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 14.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.1 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.1 }, { "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 Duals - My Care", "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": 14.1, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 13.0, "10th_percentile": 13.0, "90th_percentile": 13.0, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.94, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": 14.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 12.13, "10th_percentile": 8.39, "90th_percentile": 12.13, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.1, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.1 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.1, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.1 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.3, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.1, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 14.1 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.1, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.1 }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 12.86, "10th_percentile": 12.86, "90th_percentile": 12.86, "count": "21" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.88 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.1, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "APIXABAN ANTI-Xa LC", "code_information": [ { "code": "85130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 975.0, "discounted_cash": 11.0, "minimum": 10.7, "maximum": 955.5, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 11.89, "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": 19.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.41 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.64 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.24, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.72, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 12.48, "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": 16.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.24, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.41 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.27, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.08, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.62, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 11.41 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 11.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.65, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.72, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.7 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.78, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANOXIC & OTHER SEVERE BRAIN DAMAGE - SOI : 3", "code_information": [ { "code": "0593", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13740.347, "maximum": 14702.17, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 14427.36 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 14152.56 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 13740.35 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 14289.96 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 13740.35 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 14152.56 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13740.35 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 13740.35 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 14702.17 } ] } ] }, { "description": "ARTHROGRAM HIP RIGHT (R)", "code_information": [ { "code": "73525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1929.4, "discounted_cash": 328.0, "minimum": 64.23, "maximum": 1890.812, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 201.16 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 197.33 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 525.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 195.41 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 351.43, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 191.58 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 491.67, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 394.13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 197.33 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 361.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 486.75, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 476.93, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "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 Duals", "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": 201.16 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 321.87, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 64.23 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 491.02, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANTINUCLEAR ANTIBODIES LC52029", "code_information": [ { "code": "86038", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 520.0, "discounted_cash": 12.0, "minimum": 1.7568, "maximum": 509.6, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 2.04, "10th_percentile": 1.41, "90th_percentile": 2.04, "count": "68" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 19.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 13.0, "10th_percentile": 13.0, "90th_percentile": 13.0, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.94, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 12.13, "10th_percentile": 8.39, "90th_percentile": 12.13, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.53, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.51, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.3, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.56, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 12.86, "10th_percentile": 12.86, "90th_percentile": 12.86, "count": "21" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.88 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.07, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS - SOI : 2", "code_information": [ { "code": "2332", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12515.718, "maximum": 13391.82, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 13141.5 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 12891.19 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 12515.72 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 13016.35 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 12515.72 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 12891.19 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12515.72 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 12515.72 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 13391.82 } ] } ] }, { "description": "ANTEPARTUM WITH O.R. PROCEDURE- SOI : 1", "code_information": [ { "code": "5471", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5783.857, "maximum": 6188.73, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 6073.05 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5957.37 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5783.86 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 6015.21 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5783.86 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 5957.37 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5783.86 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 5783.86 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6188.73 } ] } ] }, { "description": "ARTHROGRAM SHOULDER LT", "code_information": [ { "code": "73040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1929.4, "discounted_cash": 328.0, "minimum": 67.19, "maximum": 2647.1368, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 525.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 351.43, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 476.24, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 491.67, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 394.13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 361.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 486.75, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 476.93, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 321.87, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 67.19 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 491.02, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANTIPANCREATIC ISLET CELLS", "code_information": [ { "code": "86341", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 71.68, "discounted_cash": 23.0, "minimum": 10.3219, "maximum": 401.8, "payers_information": [ { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 28.28, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.94 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 25.93, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 34.93, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 34.23, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 23.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.56 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.1, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 23.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 25.22, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.21 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.24, "additional_payer_notes": "149.50% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.56 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 71.28, "10th_percentile": 71.28, "90th_percentile": 71.28, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.94 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 23.57, "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": 37.71, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.63 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 24.28, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 24.28, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.18, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 25.22, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 24.75, "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": 33.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 34.18, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 35.28, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS - SOI : 4", "code_information": [ { "code": "2344", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15251.801, "maximum": 16319.43, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 16014.39 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 15709.36 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 15251.8 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 15861.87 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 15251.8 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 15709.36 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15251.8 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 15251.8 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 16319.43 } ] } ] }, { "description": "ANTEPARTUM WITHOUT O.R. PROCEDURE- SOI : 4", "code_information": [ { "code": "5664", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12092.223, "maximum": 12938.68, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 12696.83 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 12454.99 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 12092.22 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 12575.91 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 12092.22 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 12454.99 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12092.22 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 12092.22 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12938.68 } ] } ] }, { "description": "ARTHROSCOPY", "code_information": [ { "code": "509", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5252.0, "maximum": 19063.1, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19063.1 }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 11900.84 } ] } ] }, { "description": "ANTIPARIETAL CELL ANTIBODY", "code_information": [ { "code": "83516", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40.75, "discounted_cash": 11.0, "minimum": 3.8088, "maximum": 641.655, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 3.05, "10th_percentile": 3.05, "90th_percentile": 3.81, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 18.45, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.34, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.26, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.09, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.74, "additional_payer_notes": "145.21% 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 Duals", "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": 11.3, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.38 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.24, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "APPLICATION FOREARM CAST", "code_information": [ { "code": "29075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1199.55, "discounted_cash": 263.0, "minimum": 141.44, "maximum": 1199.55, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.51 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 145.68 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 421.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 141.44 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 144.27 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 281.74, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 141.44 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 315.97, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 145.68 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 289.64, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 390.23, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 141.44 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 382.35, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 141.44 }, { "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 Duals", "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": 148.51 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 258.04, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 393.65, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANTERIOR MIDSHAFT PLATE 8-HOLE", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "ASSAY DIPROPYLACETIC ACD TOT", "code_information": [ { "code": "80164", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 41.98, "discounted_cash": 13.0, "minimum": 6.0451, "maximum": 143.08, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 21.03, "10th_percentile": 21.02, "90th_percentile": 21.03, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "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": 21.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 13.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.49, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 14.22, "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": 18.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 58.4, "10th_percentile": 58.4, "90th_percentile": 125.56, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.27, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 16.25, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.07, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.66, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 133.15, "10th_percentile": 133.15, "90th_percentile": 133.15, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.27, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.49, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.19 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "149.50% 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": 33672.0, "minimum": 1969.5, "maximum": 53876.032, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 30256.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 30256.3, "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": 53876.03, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 30256.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 31163.99, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 31163.99, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 48825.15, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 32374.24, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 35356.15, "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": 43774.28, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 31163.99, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 30256.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 48825.15, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 30256.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 40777.42, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 40407.02, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 53876.03, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 33281.93, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 40369.98, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 39555.11, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33672.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6705.67 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 30256.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 51104.94 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 30256.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 29651.17, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 33672.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 36029.6, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 21777.01 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 40777.42, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "APPLICATION OF SKIN GRAFT SUB", "code_information": [ { "code": "15275", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8113.7, "discounted_cash": 695.0, "minimum": 372.86, "maximum": 8629.3, "payers_information": [ { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 695.78, "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": 1113.25, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 695.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 716.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 716.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1008.88, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 744.48, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 730.57, "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": 974.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 695.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 695.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1008.88, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 695.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1041.58, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 834.94, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 765.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1031.15, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1973.35 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1010.34, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 695.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 695.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 695.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 681.86, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 695.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 744.48, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1040.19, "additional_payer_notes": "149.50% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 695.78, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANTI - JO - 1 ANTIBODIES", "code_information": [ { "code": "86235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 73.3, "discounted_cash": 17.0, "minimum": 3.3696, "maximum": 3317.79, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.56 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 5.76, "10th_percentile": 3.43, "90th_percentile": 18.0, "count": "12" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.94 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 28.69, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.63 }, { "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 Duals - My Care", "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": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 36.88, "10th_percentile": 36.88, "90th_percentile": 124.84, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.19, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 31.01 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.84, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 21.52, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.94 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 19.72, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.57, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.04, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 123.48, "10th_percentile": 123.48, "90th_percentile": 123.48, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 32.56 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.57, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.14 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.81, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ASSAY GALACTOSE TRANSFERASE", "code_information": [ { "code": "82775", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 440.0, "discounted_cash": 21.0, "minimum": 18.96, "maximum": 431.2, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.6 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.11 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "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": 33.71, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.87 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.55, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 22.54, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 22.12, "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": 29.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 30.55, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.54, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 25.28, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.11 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 23.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.23, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 30.6, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.65, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22.54, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.5, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "APICAL LORDOTIC VIEW - 71045 - 3240013", "code_information": [ { "code": "71045", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 311.5, "discounted_cash": 81.0, "minimum": 11.07, "maximum": 427.378, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 79.9, "10th_percentile": 8.11, "90th_percentile": 332.75, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "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": 131.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 84.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 84.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 118.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 402.08, "10th_percentile": 402.08, "90th_percentile": 402.08, "count": "24" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 87.67, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 86.03, "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": 114.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 131.92, "10th_percentile": 131.92, "90th_percentile": 131.92, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 8.11, "10th_percentile": 8.11, "90th_percentile": 8.11, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 375.05, "10th_percentile": 174.44, "90th_percentile": 375.05, "count": "69" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 118.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 122.65, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 98.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 90.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 121.42, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 118.97, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 397.72, "10th_percentile": 397.72, "90th_percentile": 397.72, "count": "102" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80.29, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 81.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 87.67, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.07 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 122.49, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "APPLY FOREARM SPLINT", "code_information": [ { "code": "29125", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 545.15, "discounted_cash": 125.0, "minimum": 75.86, "maximum": 534.247, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 79.65 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 853.0, "10th_percentile": 853.0, "90th_percentile": 853.01, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.14 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 200.4, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.86 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.38 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 134.02, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 468.83, "10th_percentile": 468.83, "90th_percentile": 468.83, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 75.86 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 150.3, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.14 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 137.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 185.62, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 75.86 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 181.88, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.86 }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 497.18, "10th_percentile": 497.18, "90th_percentile": 497.18, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 79.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 122.75, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 187.25, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANTI SMOOTH MUSCLE AB", "code_information": [ { "code": "83516", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26.45, "discounted_cash": 11.0, "minimum": 3.8088, "maximum": 641.655, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 3.05, "10th_percentile": 3.05, "90th_percentile": 3.81, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 18.45, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.34, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.26, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.09, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.74, "additional_payer_notes": "145.21% 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 Duals", "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": 11.3, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.38 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.24, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ASSAY OF COPPER", "code_information": [ { "code": "82525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 63.45, "discounted_cash": 12.0, "minimum": 3.6, "maximum": 189.875, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 3.6, "10th_percentile": 2.88, "90th_percentile": 3.6, "count": "11" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 12.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.99, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "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": 17.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.99, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.58, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 21.78 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.02, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 22.8, "10th_percentile": 22.8, "90th_percentile": 22.8, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.16, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.17 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.55, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "APOLOPOPROTEIN A1", "code_information": [ { "code": "82172", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 24.0, "discounted_cash": 21.0, "minimum": 3.456, "maximum": 209.3378, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.0 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 18.0, "10th_percentile": 16.49, "90th_percentile": 25.72, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.0 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 24.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.0 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.0 }, { "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 Duals - My Care", "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": 24.0, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 22.13, "10th_percentile": 22.13, "90th_percentile": 22.13, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 22.57, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": 24.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 24.0, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.0 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 24.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.0 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 23.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.0, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.0 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.0, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.0 }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 114.0, "10th_percentile": 114.0, "90th_percentile": 114.0, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 24.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.0, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "APTT ACT PARTIAL THROMBO TIME", "code_information": [ { "code": "85730", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 120.5, "discounted_cash": 6.0, "minimum": 5.41, "maximum": 118.09, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 17.35, "10th_percentile": 17.35, "90th_percentile": 17.36, "count": "26" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "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": 9.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 6.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 6.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.71, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 111.1, "10th_percentile": 111.1, "90th_percentile": 111.1, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.43, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 6.31, "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": 8.41, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 103.63, "10th_percentile": 48.2, "90th_percentile": 103.63, "count": "25" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.71, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 7.21, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8.91, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 13.05 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8.73, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 109.9, "10th_percentile": 109.9, "90th_percentile": 109.9, "count": "39" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.89, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.43, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.41 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.98, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANTIBODY TITER", "code_information": [ { "code": "86886", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 95.58, "discounted_cash": 160.0, "minimum": 4.66, "maximum": 95.58, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.28 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 41.3, "10th_percentile": 41.3, "90th_percentile": 41.3, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.53 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 95.58, "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": 95.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.41 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.16 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 95.58, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 95.58, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 95.58, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 95.58, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 95.58, "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": 95.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 95.58, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.41 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 95.58, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 95.58, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.53 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 95.58, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 95.58, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 37.41 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 95.58, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 95.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 95.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.28 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.58, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 95.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 95.58, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.66 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 95.58, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ASSAY OF CREATINE", "code_information": [ { "code": "82540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 412.5, "discounted_cash": 4.0, "minimum": 2.7864, "maximum": 404.25, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "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": 7.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 4.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 4.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.73, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.96, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 4.87, "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": 6.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.73, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6.95, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 5.57, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6.74, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 376.2, "10th_percentile": 376.2, "90th_percentile": 376.2, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.55, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.96, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.18 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.94, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS - SOI : 1", "code_information": [ { "code": "2331", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10534.913, "maximum": 11272.36, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 11061.66 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 10850.96 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 10534.91 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 10956.31 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 10534.91 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 10850.96 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10534.91 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 10534.91 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 11272.36 } ] } ] }, { "description": "ARHTROGRAM KNEE RIGHT", "code_information": [ { "code": "73580", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1929.4, "discounted_cash": 328.0, "minimum": 51.19, "maximum": 1890.812, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 201.16 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 197.33 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 525.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 195.41 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 351.43, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 191.58 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 491.67, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 394.13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 197.33 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 361.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 486.75, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 476.93, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "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 Duals", "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": 201.16 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 321.87, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.19 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 491.02, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANTIGEN CHARGE:AG:Ea.ADD 1/2", "code_information": [ { "code": "86902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 48.5, "discounted_cash": 337.0, "minimum": 5.72, "maximum": 48.5, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.28 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.53 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 48.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 48.5, "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": 48.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.41 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 48.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.16 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 48.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 48.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 48.5, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 48.5, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 48.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 48.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 48.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 48.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 48.5, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.41 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 48.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 48.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 48.5, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.53 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 48.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 48.5, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 37.41 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 48.5, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 48.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 48.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 48.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.28 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 48.5, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 48.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 48.5, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.72 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 48.5, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ASSAY OF G6PD ENZYME", "code_information": [ { "code": "82955", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22.88, "discounted_cash": 9.0, "minimum": 3.2947, "maximum": 22.4224, "payers_information": [ { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.38, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.73 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.5, "additional_payer_notes": "149.50% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.58 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.26 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "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": 15.52, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.11 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 9.99, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 9.99, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.07, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 21.1, "10th_percentile": 21.1, "90th_percentile": 21.1, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.38, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 10.19, "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": 13.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.07, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.52, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 11.64, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.26 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 10.67, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.38, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.09, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.58 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.51, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS - SOI : 1", "code_information": [ { "code": "2341", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6170.487, "maximum": 6602.42, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 6479.01 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 6355.6 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6170.49 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 6417.31 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6170.49 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 6355.6 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6170.49 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 6170.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6602.42 } ] } ] }, { "description": "ARSENIC - 82175 - 3001638", "code_information": [ { "code": "82175", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 169.0, "discounted_cash": 18.0, "minimum": 4.2134, "maximum": 165.62, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.87 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.43 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 30.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.78 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.22 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.3, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 21.78 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 28.4, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.43 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 20.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 28.11, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 21.78 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.55, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.78 }, { "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 Duals", "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": 22.87 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.59, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.36, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANTIGLIADIN IgG", "code_information": [ { "code": "86258", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 100.0, "discounted_cash": 12.0, "minimum": 3.1104, "maximum": 512.05, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 4.91, "10th_percentile": 3.12, "90th_percentile": 75.24, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 19.28, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.89, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.86, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.5, "additional_payer_notes": "145.21% 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 Duals", "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": 11.81, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.85 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.01, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ASSAY OF IGE - 82785 - 3010632", "code_information": [ { "code": "82785", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 38.89, "discounted_cash": 16.0, "minimum": 3.06, "maximum": 225.4, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 5.61, "10th_percentile": 5.6, "90th_percentile": 5.61, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 26.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.61, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 19.75, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 18.11, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.39, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 23.9, "additional_payer_notes": "145.21% 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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 32.82, "10th_percentile": 32.82, "90th_percentile": 35.47, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 16.13, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.81 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.61, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "APPENDIX PROCEDURES WITH CC", "code_information": [ { "code": "398", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12427.0, "minimum": 3939.0, "maximum": 25568.4, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11202.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 11202.7, "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": 19883.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11202.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 11538.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 11538.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 18019.21, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11986.89, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 13048.39, "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": 16155.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11538.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 11202.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18019.21, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 11202.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15049.15, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 14912.45, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 19883.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 12322.97, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14898.78, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14598.04, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12427.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25568.4 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 11202.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 18316.07 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 11202.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10978.65, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 12427.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 13296.93, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 9563.2 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15049.15, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ARTERIAL BLOOD DRAWING", "code_information": [ { "code": "36600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 532.4, "discounted_cash": 125.0, "minimum": 47.9881, "maximum": 521.752, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.39 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.43 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 200.4, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.99 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.95 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 134.02, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 47.99 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 150.3, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.43 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 137.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 185.62, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 47.99 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 181.88, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.99 }, { "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 Duals", "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": 50.39 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 122.75, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 187.25, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ANTIPROTEINASE 3 (PR-3) AB", "code_information": [ { "code": "83520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 52.44, "discounted_cash": 17.0, "minimum": 7.5514, "maximum": 820.064, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 17.28, "10th_percentile": 17.28, "90th_percentile": 25.72, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "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": 27.63, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.04, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 129.08, "10th_percentile": 129.08, "90th_percentile": 129.08, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.48, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 18.13, "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": 24.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 59.56, "10th_percentile": 59.56, "90th_percentile": 185.76, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 25.04, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.85, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 19.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.59, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.08, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 82.08, "10th_percentile": 82.08, "90th_percentile": 82.08, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.92, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.48, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.54 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.82, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ASSAY PSA TOTAL LC", "code_information": [ { "code": "84153", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 120.0, "discounted_cash": 18.0, "minimum": 12.9485, "maximum": 202.8502, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 29.81, "10th_percentile": 17.28, "90th_percentile": 29.81, "count": "74" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "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": 29.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 18.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 18.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.67, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 146.6, "10th_percentile": 146.6, "90th_percentile": 146.6, "count": "17" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.68, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "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": 25.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 36.0, "10th_percentile": 36.0, "90th_percentile": 36.0, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 51.0, "10th_percentile": 51.0, "90th_percentile": 136.74, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 136.74, "10th_percentile": 136.74, "90th_percentile": 136.74, "count": "29" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 26.67, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.07, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 20.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.25, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.7, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 145.01, "10th_percentile": 109.44, "90th_percentile": 188.77, "count": "59" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.02, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.68, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.55 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.49, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "APPLICATION OF TENS", "code_information": [ { "code": "97014", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 128.77, "minimum": 38.631, "maximum": 283.1808, "payers_information": [ { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 109.41, "10th_percentile": 96.91, "90th_percentile": 124.51, "count": "1 through 10" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 41.78 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 132.04, "10th_percentile": 132.04, "90th_percentile": 132.05, "count": "14" } ] } ] }, { "description": "ARTHREX CANNULATED INT SCREW", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 194.46, "10th_percentile": 194.46, "90th_percentile": 194.46, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 232.43, "10th_percentile": 232.43, "90th_percentile": 232.43, "count": "1 through 10" } ] } ] }, { "description": "AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC", "code_information": [ { "code": "268", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 54487.0, "minimum": 7878.0, "maximum": 87180.08, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 48923.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 48923.9, "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": 87180.08, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 48923.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 50391.62, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 50391.62, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 79006.95, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 52348.57, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 57211.93, "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": 70833.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 50391.62, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 48923.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 79006.95, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 48923.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 65984.42, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 65385.06, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 87180.08, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 53816.29, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 65325.12, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 64006.52, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 54487.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14751.7 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 48923.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 83229.47 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 48923.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 47945.42, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 54487.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 58301.68, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 27671.51 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 65984.42, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ASTHMA - SOI : 3", "code_information": [ { "code": "1413", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6710.87, "maximum": 7180.63, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 7046.41 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 6912.2 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6710.87 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 6979.3 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6710.87 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 6912.2 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6710.87 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 6710.87 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7180.63 } ] } ] }, { "description": "APPLY FINGER SPLINT STATIC", "code_information": [ { "code": "29130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 275.05, "discounted_cash": 125.0, "minimum": 75.86, "maximum": 273.91, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 79.65 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.14 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 200.4, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.86 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.38 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 134.02, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 236.54, "10th_percentile": 236.54, "90th_percentile": 236.54, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 75.86 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 150.3, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.14 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 137.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 185.62, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 75.86 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 181.88, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.86 }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 250.85, "10th_percentile": 250.85, "90th_percentile": 250.85, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 79.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 122.75, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 187.25, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ARTHROGRAM ANKLE LEFT (R)", "code_information": [ { "code": "73615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1929.4, "discounted_cash": 328.0, "minimum": 64.23, "maximum": 1890.812, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 525.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 351.43, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 476.24, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 491.67, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 394.13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 361.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 486.75, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 476.93, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 321.87, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 64.23 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 491.02, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "APOLIPOPPROTEIN", "code_information": [ { "code": "82172", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 213.61, "discounted_cash": 21.0, "minimum": 3.456, "maximum": 209.3378, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 18.0, "10th_percentile": 16.49, "90th_percentile": 25.72, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 33.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 22.13, "10th_percentile": 22.13, "90th_percentile": 22.13, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 22.57, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 30.58, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.57, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 25.31, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 23.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.26, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 30.62, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 114.0, "10th_percentile": 114.0, "90th_percentile": 114.0, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.53, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ATHEROSCLEROSIS WITHOUT MCC", "code_information": [ { "code": "303", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5837.0, "minimum": 2363.4, "maximum": 9340.176, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 5293.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 5293.05, "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": 9340.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5293.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 5451.84, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 5451.84, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 8464.53, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5663.56, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 6129.49, "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": 7588.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5451.84, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 5293.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8464.53, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 5293.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7069.35, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 7005.13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 9340.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 5822.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6998.71, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6857.44, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5837.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5093.54 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 5293.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 8146.39 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 5293.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5187.19, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 5837.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 6246.24, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6113.12 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7069.35, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "APTT MIX", "code_information": [ { "code": "85732", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44.05, "discounted_cash": 6.0, "minimum": 5.82, "maximum": 130.6634, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 43.98, "10th_percentile": 43.98, "90th_percentile": 43.98, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 10.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.92, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9.69, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 7.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 7.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9.59, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 13.05 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9.4, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.34, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.82 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.67, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ARTHROGRAM ANKLE LEFT - 73615 - 3220018", "code_information": [ { "code": "73615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1929.4, "discounted_cash": 328.0, "minimum": 64.23, "maximum": 1890.812, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 201.16 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 197.33 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 525.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 195.41 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 351.43, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 191.58 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 491.67, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 394.13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 197.33 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 361.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 486.75, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 476.93, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "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 Duals", "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": 201.16 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 321.87, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 64.23 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 491.02, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS - SOI : 3", "code_information": [ { "code": "2333", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 19485.851, "maximum": 20849.86, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 20460.14 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 20070.43 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 19485.85 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 20265.29 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 19485.85 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 20070.43 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 19485.85 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 19485.85 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 20849.86 } ] } ] }, { "description": "AUTOANTIBODY ELSIA", "code_information": [ { "code": "83520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 56.26, "discounted_cash": 17.0, "minimum": 7.5514, "maximum": 820.064, "payers_information": [ { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.63, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.04, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 129.08, "10th_percentile": 129.08, "90th_percentile": 129.08, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.48, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 18.13, "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": 24.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 59.56, "10th_percentile": 59.56, "90th_percentile": 185.76, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 25.04, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.85, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 19.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.59, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.08, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 82.08, "10th_percentile": 82.08, "90th_percentile": 82.08, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.92, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.48, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.54 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.82, "additional_payer_notes": "149.50% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 17.28, "10th_percentile": 17.28, "90th_percentile": 25.72, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "APTTMX", "code_information": [ { "code": "85730", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 100.01, "discounted_cash": 6.0, "minimum": 5.41, "maximum": 118.09, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.7 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 17.35, "10th_percentile": 17.35, "90th_percentile": 17.36, "count": "26" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "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": 9.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.05 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.31 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 6.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 6.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.71, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 111.1, "10th_percentile": 111.1, "90th_percentile": 111.1, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.43, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 6.31, "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": 8.41, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 103.63, "10th_percentile": 48.2, "90th_percentile": 103.63, "count": "25" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.71, "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": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 7.21, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8.91, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 13.05 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8.73, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.05 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 109.9, "10th_percentile": 109.9, "90th_percentile": 109.9, "count": "39" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.89, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.43, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.41 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.98, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ARTHROGRAM ELBOW LEFT - 73085 - 3240027", "code_information": [ { "code": "73085", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1929.4, "discounted_cash": 328.0, "minimum": 47.5, "maximum": 1890.812, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 201.16 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 197.33 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 525.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 195.41 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 351.43, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 191.58 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 491.67, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 394.13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 197.33 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 361.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 486.75, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 476.93, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "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 Duals", "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": 201.16 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 321.87, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.5 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 491.02, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "APPENDIX PROCEDURES WITH MCC", "code_information": [ { "code": "397", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19337.0, "minimum": 6696.3, "maximum": 30939.44, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 17399.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 17399.9, "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": 30939.44, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17399.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 17921.9, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 17921.9, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 28038.87, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18617.89, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 20304.01, "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": 25138.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17921.9, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 17399.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 28038.87, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 17399.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 23417.29, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 23204.58, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 30939.44, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 19139.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 23183.31, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 22715.35, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19337.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28434.8 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 17399.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 28980.68 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 17399.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17051.9, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 19337.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 20690.75, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 11416.19 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 23417.29, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CCMCC", "code_information": [ { "code": "017", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 43152.0, "minimum": 21401.9, "maximum": 73350.0, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 38758.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 37983.43, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 43152.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 46173.56, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 27778.75 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 52258.11, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 38758.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 38758.6, "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": 69044.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 38758.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 39921.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 39921.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 62571.65, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 41471.7, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 45310.5, "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": 56098.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 39921.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 38758.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 62571.65, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 38758.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 52258.11, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 51783.43, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 69044.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 42634.46, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 51735.96, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 50691.66, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 43152.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 65500.3 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 38758.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 65736.26 } ] } ] }, { "description": "ARTHROGRAM HIP LEFT - 73525 - 3220035", "code_information": [ { "code": "73525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1929.4, "discounted_cash": 328.0, "minimum": 64.23, "maximum": 1890.812, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 525.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 351.43, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 476.24, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 491.67, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 394.13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 361.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 486.75, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 476.93, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 321.87, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 64.23 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 491.02, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "APPENDIX PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "399", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9534.0, "minimum": 2494.7, "maximum": 16446.0, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8608.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 8608.6, "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": 15255.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8608.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 8866.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 8866.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 13825.11, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9211.2, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 10011.29, "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": 12394.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8866.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 8608.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13825.11, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8608.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11546.35, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 11441.47, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 15255.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 9469.46, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11430.98, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11200.25, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9534.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16446.0 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 8608.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 13852.01 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 8608.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8436.43, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 9534.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 10201.98, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7878.66 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11546.35, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "B CELLS TOTAL COUNT - 86355 - 3021045", "code_information": [ { "code": "86355", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 662.5, "discounted_cash": 37.0, "minimum": 9.3326, "maximum": 649.25, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 60.37, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 40.37, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 54.71, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 56.48, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 45.28, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 41.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 55.92, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 38.51 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 54.79, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.98, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.96 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 56.41, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ARTHROGRAM SHOULDER LT (R)", "code_information": [ { "code": "73040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1929.4, "discounted_cash": 328.0, "minimum": 67.19, "maximum": 2647.1368, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 201.16 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 197.33 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 525.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 195.41 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 351.43, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 191.58 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 491.67, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 394.13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 197.33 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 361.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 486.75, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 476.93, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "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 Duals", "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": 201.16 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 321.87, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 67.19 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 491.02, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "APPLICATION SHORT LEG SPLINT", "code_information": [ { "code": "29515", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 668.7, "discounted_cash": 152.0, "minimum": 75.86, "maximum": 655.326, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 79.65 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 853.0, "10th_percentile": 853.0, "90th_percentile": 853.0, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.14 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 244.77, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.86 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.38 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 163.69, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 200.61, "10th_percentile": 200.61, "90th_percentile": 200.61, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 75.86 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 183.58, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.14 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 168.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 226.72, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 75.86 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 222.14, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.86 }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 609.85, "10th_percentile": 609.85, "90th_percentile": 609.85, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 79.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 149.92, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 228.71, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "B CELLS TOTAL COUNT LC", "code_information": [ { "code": "86355", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 167.7, "discounted_cash": 37.0, "minimum": 9.3326, "maximum": 649.25, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 60.37, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 40.37, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 54.71, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 56.48, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 45.28, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 41.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 55.92, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 38.51 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 54.79, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.98, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.96 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 56.41, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ARSENIC - 82175 - 3005049", "code_information": [ { "code": "82175", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40.0, "discounted_cash": 18.0, "minimum": 4.2134, "maximum": 165.62, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 30.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.3, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 27.51, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 28.4, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 20.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 28.11, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 21.78 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.55, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.59, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.36, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ARTHROGRAM SHOULDER RT - 73040 - 3240050", "code_information": [ { "code": "73040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1929.4, "discounted_cash": 328.0, "minimum": 67.19, "maximum": 2647.1368, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 525.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 351.43, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 476.24, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 491.67, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 394.13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 361.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 486.75, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 476.93, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 321.87, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 67.19 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 491.02, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "APPLY LONG ARM SPLINT", "code_information": [ { "code": "29105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 668.7, "discounted_cash": 152.0, "minimum": 75.86, "maximum": 923.4932, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 244.77, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 163.69, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 575.08, "10th_percentile": 575.08, "90th_percentile": 575.08, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 183.58, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 168.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 226.72, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 75.86 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 222.14, "additional_payer_notes": "145.21% 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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 609.85, "10th_percentile": 609.85, "90th_percentile": 609.85, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 149.92, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 228.71, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "B. HENSELAE IgG", "code_information": [ { "code": "86611", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 53.05, "discounted_cash": 10.0, "minimum": 7.6392, "maximum": 51.989, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.56 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.94 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 16.29, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.63 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.89, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 31.01 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.24, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.94 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.09, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "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 Duals", "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": 32.56 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.98, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.22, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ARTHREX#AR-2324BCC-2 (SWIVEL)", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 194.46, "10th_percentile": 194.46, "90th_percentile": 194.46, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 232.43, "10th_percentile": 232.43, "90th_percentile": 232.43, "count": "1 through 10" } ] } ] }, { "description": "ARTHROGRAM WRIST LEFT - 73115 - 3240062", "code_information": [ { "code": "73115", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1929.4, "discounted_cash": 328.0, "minimum": 68.91, "maximum": 2647.1368, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 525.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 351.43, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 476.24, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 491.67, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 394.13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 361.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 486.75, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 476.93, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 321.87, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.91 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 491.02, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "APPLY LONG LEG SPLINT", "code_information": [ { "code": "29505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 668.7, "discounted_cash": 152.0, "minimum": 75.86, "maximum": 655.326, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 79.65 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.14 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 244.77, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.86 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.38 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 163.69, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 75.86 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 183.58, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.14 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 168.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 226.72, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 75.86 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 222.14, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.86 }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 609.85, "10th_percentile": 609.85, "90th_percentile": 609.85, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 79.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 149.92, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 228.71, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "B. PERTUSSIS AB IgG", "code_information": [ { "code": "86615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 65.96, "discounted_cash": 13.0, "minimum": 9.4982, "maximum": 73.451, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 10.8, "10th_percentile": 10.79, "90th_percentile": 10.8, "count": "11" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 21.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.11, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 17.99, "10th_percentile": 17.99, "90th_percentile": 17.99, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 19.13, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.83, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.51, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.55, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.15, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 68.35, "10th_percentile": 68.35, "90th_percentile": 68.35, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.93, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.72, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ARTHROGRAM ANKLE RIGHT - 73615 - 3240015", "code_information": [ { "code": "73615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1929.4, "discounted_cash": 328.0, "minimum": 64.23, "maximum": 1890.812, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 525.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 351.43, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 476.24, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 491.67, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 394.13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 361.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 486.75, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 476.93, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 321.87, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 64.23 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 491.02, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ARTHROGRAM WRIST RIGHT - 73115 - 3220059", "code_information": [ { "code": "73115", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1929.4, "discounted_cash": 328.0, "minimum": 68.91, "maximum": 2647.1368, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 525.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 351.43, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 476.24, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 491.67, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 394.13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 361.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 486.75, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 476.93, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 321.87, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.91 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 491.02, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "APPLY MULTLAYR CMPRS LWR LEG B", "code_information": [ { "code": "29581", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 728.8, "discounted_cash": 152.0, "minimum": 141.44, "maximum": 728.8, "payers_information": [ { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 141.44 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 183.58, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 145.68 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 168.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 226.72, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 141.44 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 222.14, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 141.44 }, { "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 Duals", "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": 148.51 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 149.92, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 228.71, "additional_payer_notes": "149.50% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.51 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 145.68 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 244.77, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 141.44 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 144.27 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 163.69, "additional_payer_notes": "107.00% of Medicare Rates" } ] } ] }, { "description": "B. QUINTATA IgG", "code_information": [ { "code": "86611", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 53.05, "discounted_cash": 10.0, "minimum": 7.6392, "maximum": 51.989, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 16.29, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.89, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.76, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.24, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.09, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.98, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.22, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ARTHROGRAM ELBOW LEFT (R)", "code_information": [ { "code": "73085", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1929.4, "discounted_cash": 328.0, "minimum": 47.5, "maximum": 1890.812, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 525.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 351.43, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 476.24, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 491.67, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 394.13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 361.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 486.75, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 476.93, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 321.87, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.5 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 491.02, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ARTHROGRAM WRIST RIGHT - 73115 - 3240059", "code_information": [ { "code": "73115", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1929.4, "discounted_cash": 328.0, "minimum": 68.91, "maximum": 2647.1368, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 525.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 351.43, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 476.24, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 491.67, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 394.13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 361.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 486.75, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 476.93, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 321.87, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.91 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 491.02, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "Apply short leg cast", "code_information": [ { "code": "29405", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2033.48, "discounted_cash": 263.0, "minimum": 141.44, "maximum": 2033.48, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.51 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 145.68 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 421.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 141.44 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 144.27 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 281.74, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 141.44 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 315.97, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 145.68 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 289.64, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 390.23, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 141.44 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 382.35, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 141.44 }, { "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 Duals", "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": 148.51 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 258.04, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 393.65, "additional_payer_notes": "149.50% 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": 29862.0, "minimum": 7090.2, "maximum": 47780.272, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 26839.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 26839.5, "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": 47780.27, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 26839.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 27644.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 27644.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 43300.87, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 28718.27, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 31355.8, "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": 38821.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 27644.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 26839.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 43300.87, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 26839.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 36163.69, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 35835.2, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 47780.27, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 29523.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 35802.36, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 35079.68, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 29862.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32216.4 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 26839.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 45225.07 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 26839.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 26302.71, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 29862.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 31953.06, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 24539.01 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 36163.69, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ARTHROGRAM ELBOW LEFT - 73085 - 3220027", "code_information": [ { "code": "73085", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1929.4, "discounted_cash": 328.0, "minimum": 47.5, "maximum": 1890.812, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 525.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 351.43, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 476.24, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 491.67, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 394.13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 361.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 486.75, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 476.93, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 321.87, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.5 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 491.02, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "AS-1 CR-CS-CEMENTED BP - C1776 - 2783150", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 9453.57, "10th_percentile": 9453.57, "90th_percentile": 9453.57, "count": "1 through 10" } ] } ] }, { "description": "Apresoline", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "63323061401", "type": "NDC" }, { "code": "J0360", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 31.43, "10th_percentile": 31.43, "90th_percentile": 31.43, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 35.95, "10th_percentile": 35.95, "90th_percentile": 35.95, "count": "1 through 10" } ] } ] }, { "description": "BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM - SOI : 1", "code_information": [ { "code": "0491", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7352.856, "maximum": 7867.56, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 7720.5 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7573.44 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7352.86 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 7646.97 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7352.86 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 7573.44 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7352.86 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 7352.86 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7867.56 } ] } ] }, { "description": "ARTHROGRAM ELBOW RIGHT (R)", "code_information": [ { "code": "73085", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1929.4, "discounted_cash": 328.0, "minimum": 47.5, "maximum": 1890.812, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 525.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 351.43, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 476.24, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 491.67, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 394.13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 361.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 486.75, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 476.93, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 321.87, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.5 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 491.02, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "AS-1 CR-CS-CEMENTED BP - C1776 - 2784223", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 9453.57, "10th_percentile": 9453.57, "90th_percentile": 9453.57, "count": "1 through 10" } ] } ] }, { "description": "APTTMXS", "code_information": [ { "code": "85732", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 133.33, "discounted_cash": 6.0, "minimum": 5.82, "maximum": 130.6634, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 43.98, "10th_percentile": 43.98, "90th_percentile": 43.98, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 10.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.92, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9.69, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 7.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 7.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9.59, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 13.05 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9.4, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.34, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.82 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.67, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC", "code_information": [ { "code": "095", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20782.0, "minimum": 7221.5, "maximum": 33251.536, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 18695.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 18695.9, "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": 33251.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 18695.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 19256.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 19256.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 30134.2, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20004.61, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 21821.32, "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": 27016.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19256.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 18695.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 30134.2, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 18695.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 25167.26, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 24938.65, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 33251.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 20565.49, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 24915.79, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 24412.86, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20782.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24901.6 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 18695.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 31210.9 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 18695.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18321.98, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 20782.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 22236.96, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 12010.84 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 25167.26, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ARTHROGRAM HIP RIGHT - 73525 - 3220033", "code_information": [ { "code": "73525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1929.4, "discounted_cash": 328.0, "minimum": 64.23, "maximum": 1890.812, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 525.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 351.43, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 476.24, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 491.67, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 394.13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 361.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 486.75, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 476.93, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 321.87, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 64.23 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 491.02, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ASNIS III NON-THREADED GUIDE", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "AQUATIC THERAPY W/EXERCISE", "code_information": [ { "code": "97113", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 60.77, "discounted_cash": 35.0, "minimum": 18.231, "maximum": 194.04, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 35.28, "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": 56.45, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 36.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 36.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 51.16, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.75, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 37.04, "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": 49.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 51.16, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 42.34, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 38.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.28, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 60.77 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 51.23, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 35.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.57, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 35.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 37.75, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.74, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BARD ECHO MESH 10X13 INCH", "code_information": [ { "code": "C1781", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 2101.84, "10th_percentile": 1744.87, "90th_percentile": 5455.45, "count": "1 through 10" } ] } ] }, { "description": "ARTHROGRAM HIP RIGHT - 73525 - 3240033", "code_information": [ { "code": "73525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1929.4, "discounted_cash": 328.0, "minimum": 64.23, "maximum": 1890.812, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 525.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 351.43, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 476.24, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 491.67, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 394.13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 361.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 486.75, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 476.93, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 321.87, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 64.23 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 491.02, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "Aspergillus flavus Precipitati", "code_information": [ { "code": "86606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80.44, "discounted_cash": 15.0, "minimum": 4.6714, "maximum": 85.6912, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.56 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 4.68, "10th_percentile": 4.68, "90th_percentile": 4.68, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.94 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 24.08, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.63 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 31.01 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 22.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.94 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 16.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 22.3, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.85, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "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 Duals", "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": 32.56 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.75, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.5, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BARD SOFT MESH 6 X 6", "code_information": [ { "code": "C1781", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 2101.84, "10th_percentile": 1744.87, "90th_percentile": 5455.45, "count": "1 through 10" } ] } ] }, { "description": "ARTHROGRAM KNEE LEFT - 73580 - 3220044", "code_information": [ { "code": "73580", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1929.4, "discounted_cash": 328.0, "minimum": 51.19, "maximum": 1890.812, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 525.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 351.43, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 476.24, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 491.67, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 394.13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 361.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 486.75, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 476.93, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 321.87, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.19 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 491.02, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "Aspirate pleura w/ imaging - 32555 - OR36032555", "code_information": [ { "code": "32555", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3100.05, "discounted_cash": 590.0, "minimum": 578.7488, "maximum": 3100.05, "payers_information": [ { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 882.89, "additional_payer_notes": "149.50% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 944.9, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 590.56, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 631.9, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 590.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 590.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 884.07, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 708.67, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 649.62, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 875.21, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3100.05 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 857.55, "additional_payer_notes": "145.21% 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 Duals", "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": 578.75, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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" } ] } ] }, { "description": "ARACHIDONIC ACID", "code_information": [ { "code": "85576", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 70.35, "discounted_cash": 24.0, "minimum": 10.1304, "maximum": 230.3, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "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": 39.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 25.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 25.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.12, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 26.16, "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": 34.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 36.12, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 37.29, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 29.89, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 27.4, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 36.92, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 63.16 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 36.17, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.41, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.42 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.24, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BARD VENTRALIGHT MESH ECHO 6X8", "code_information": [ { "code": "C1781", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 2101.84, "10th_percentile": 1744.87, "90th_percentile": 5455.45, "count": "1 through 10" } ] } ] }, { "description": "ARTHROGRAM KNEE LEFT - 73580 - 3240044", "code_information": [ { "code": "73580", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1929.4, "discounted_cash": 328.0, "minimum": 51.19, "maximum": 1890.812, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 525.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 351.43, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 476.24, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 491.67, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 394.13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 361.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 486.75, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 476.93, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 321.87, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.19 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 491.02, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ASSAY IGA/IGD/IGG/IGM EACH - 82784 - 3005411", "code_information": [ { "code": "82784", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 49.7, "discounted_cash": 9.0, "minimum": 2.8166, "maximum": 50.96, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 3.12, "10th_percentile": 2.3, "90th_percentile": 7.16, "count": "20" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "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": 14.88, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 9.58, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 9.58, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.49, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 45.82, "10th_percentile": 45.82, "90th_percentile": 45.82, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.95, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "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": 13.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 18.58, "10th_percentile": 18.58, "90th_percentile": 18.58, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.49, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 13.92, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 10.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 13.78, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 13.5, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 14.59, "10th_percentile": 14.59, "90th_percentile": 45.33, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.11, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.95, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.37 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.9, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BARTONELLA DNA PCR", "code_information": [ { "code": "87471", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 659.76, "discounted_cash": 35.0, "minimum": 31.58, "maximum": 646.5648, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.43 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.53 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 56.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.17 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.07 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.55, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 45.17 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 42.11, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.53 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 38.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.0, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 45.17 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 50.95, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.17 }, { "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 Duals", "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": 47.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.39, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.58 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.46, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ARTHROGRAM KNEE RIGHT", "code_information": [ { "code": "73580", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1929.4, "discounted_cash": 328.0, "minimum": 51.19, "maximum": 1890.812, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 525.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 351.43, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 476.24, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 491.67, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 394.13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 361.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 486.75, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 476.93, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 321.87, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.19 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 491.02, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ASSAY OF ARSENIC - 82175 - 3010460", "code_information": [ { "code": "82175", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 63.15, "discounted_cash": 18.0, "minimum": 4.2134, "maximum": 165.62, "payers_information": [ { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.3, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 27.51, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 28.4, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 20.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 28.11, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 21.78 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.55, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.59, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.36, "additional_payer_notes": "149.50% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 1.33, "10th_percentile": 1.33, "90th_percentile": 12.24, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 30.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ART/ASPIR/INJ JOINT/BURSA W US", "code_information": [ { "code": "20611", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1664.32, "discounted_cash": 288.0, "minimum": 283.1906, "maximum": 1664.32, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1664.32 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1664.32 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 462.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1660.14 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 288.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1664.32 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 309.2, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 288.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 288.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 1660.14 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 432.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 346.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1664.32 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 317.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 428.25, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1660.14 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 419.61, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1660.14 }, { "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 Duals", "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": 1664.32 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 283.19, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 432.01, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BASEPLT TIB CEM PRIM TRIATH #4", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 9453.57, "10th_percentile": 9453.57, "90th_percentile": 9453.57, "count": "1 through 10" } ] } ] }, { "description": "ARYLSULFATASE A DEFICIENCY LC", "code_information": [ { "code": "82657", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 692.35, "discounted_cash": 22.0, "minimum": 19.95, "maximum": 678.503, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.6 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.11 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "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": 35.47, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.87 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 22.84, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 22.84, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.15, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 23.28, "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": 31.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 32.15, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 33.19, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 26.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.11 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 24.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 32.86, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 32.19, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.95 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.14, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ASSAY OF METANEPHRINES", "code_information": [ { "code": "83835", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 24.51, "discounted_cash": 16.0, "minimum": 3.5294, "maximum": 98.0, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 3.53, "10th_percentile": 3.53, "90th_percentile": 3.53, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% 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": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 17.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.51, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.13, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "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": 23.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 24.51, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.33, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 18.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.51, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.51 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.51, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 91.2, "10th_percentile": 22.35, "90th_percentile": 114.0, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.6, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.13, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.25 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.51, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ARTERIAL BLOOD GAS", "code_information": [ { "code": "82803", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 131.8, "discounted_cash": 26.0, "minimum": 17.4125, "maximum": 129.164, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.43 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.87 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 41.71, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.03 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.59 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 27.89, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 113.35, "10th_percentile": 113.35, "90th_percentile": 113.35, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 28.03 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 39.03, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 31.28, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.87 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 28.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 38.64, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 28.03 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 37.86, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.03 }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 120.2, "10th_percentile": 120.2, "90th_percentile": 120.2, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 29.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.46 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.97, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BASIC METABOLIC PANEL CA TOT", "code_information": [ { "code": "80048", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 155.0, "discounted_cash": 8.0, "minimum": 7.61, "maximum": 151.9, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.74 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 22.32, "10th_percentile": 22.32, "90th_percentile": 22.32, "count": "200" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.21 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 13.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.42 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.95 }, { "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 Duals - My Care", "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": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 142.91, "10th_percentile": 142.91, "90th_percentile": 142.91, "count": "58" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.05, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 141.42, "10th_percentile": 46.5, "90th_percentile": 273.02, "count": "12" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 9.36, "10th_percentile": 9.36, "90th_percentile": 9.36, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 133.3, "10th_percentile": 119.89, "90th_percentile": 133.3, "count": "100" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 26.42 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 12.66, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.15, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.21 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 9.31, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 12.54, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 26.42 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 12.28, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.42 }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 141.36, "10th_percentile": 141.36, "90th_percentile": 141.36, "count": "195" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.74 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.29, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.61 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ASCA IGA, ELSIA", "code_information": [ { "code": "83520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 56.26, "discounted_cash": 17.0, "minimum": 7.5514, "maximum": 820.064, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 17.28, "10th_percentile": 17.28, "90th_percentile": 25.72, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "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": 27.63, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.04, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 129.08, "10th_percentile": 129.08, "90th_percentile": 129.08, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.48, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 18.13, "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": 24.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 59.56, "10th_percentile": 59.56, "90th_percentile": 185.76, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 25.04, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.85, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 19.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.59, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.08, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 82.08, "10th_percentile": 82.08, "90th_percentile": 82.08, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.92, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.48, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.54 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.82, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ASSAY OF THYROGLOBULIN", "code_information": [ { "code": "84432", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 116.1, "discounted_cash": 16.0, "minimum": 1.44, "maximum": 145.53, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 16.72, "10th_percentile": 13.44, "90th_percentile": 16.72, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "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": 25.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 16.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.29, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 107.04, "10th_percentile": 107.04, "90th_percentile": 107.04, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.18, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 16.86, "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": 22.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 80.25, "10th_percentile": 16.06, "90th_percentile": 99.85, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 23.29, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 17.67, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 23.8, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 29.56 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 23.32, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 105.88, "10th_percentile": 105.88, "90th_percentile": 105.88, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.74, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.18, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.45 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.01, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ARTERIOGRAM - MESENTERIC(R)", "code_information": [ { "code": "75726", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5066.48, "discounted_cash": 5238.0, "minimum": 49.71, "maximum": 5066.48, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5066.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 5066.48, "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": 5066.48, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5066.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 5066.48, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 5066.48, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5066.48, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5066.48, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 5066.48, "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": 5066.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5066.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5066.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5066.48, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5066.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5066.48, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 5066.48, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5066.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5066.48, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3842.72 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5066.48, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5066.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5066.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 5066.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5066.48, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5066.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5066.48, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.71 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5066.48, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BCR-ABL1 TRANSCRIPT DETECTION - 81207 - 3003588", "code_information": [ { "code": "81207", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 250.0, "discounted_cash": 144.0, "minimum": 36.0, "maximum": 245.0, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 164.3 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 161.17 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 231.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 156.48 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 159.61 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 154.98, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 156.48 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 216.83, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 173.81, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 161.17 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 159.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 214.65, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 156.48 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 210.32, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 156.48 }, { "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 Duals", "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": 164.3 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.94, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 130.36 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 216.54, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ASNIS III 1.4X150mm GUIDE WIRE", "code_information": [ { "code": "C1769", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 904.16, "10th_percentile": 904.16, "90th_percentile": 904.16, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 3242.16, "10th_percentile": 3242.16, "90th_percentile": 3242.16, "count": "1 through 10" } ] } ] }, { "description": "ASSAY OTHER FLUID CHLORIDES", "code_information": [ { "code": "82438", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 133.9, "discounted_cash": 5.0, "minimum": 4.5, "maximum": 131.222, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 8.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.35, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.25, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.49, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.41, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.26, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.9, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.5 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.48, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ARTHREX ACHILLES SPEEDBRIDGE", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "BEHAVIORAL DISORDERS - SOI : 4", "code_information": [ { "code": "7584", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 33563.686, "maximum": 35913.14, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 35241.87 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 34570.6 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 33563.69 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 34906.23 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 33563.69 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 34570.6 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 33563.69 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 33563.69 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 35913.14 } ] } ] }, { "description": "ASPERGILLUS GALACTOMANAN AG", "code_information": [ { "code": "87305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 238.0, "discounted_cash": 11.0, "minimum": 10.78, "maximum": 233.24, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.48 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.03 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 19.17, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.36 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.81 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.82, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 22.36 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.03 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.75, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.36 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.4, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.36 }, { "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 Duals", "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": 23.48 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.74, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.78 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.91, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ASSAY PSA FREE LC", "code_information": [ { "code": "84154", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 120.0, "discounted_cash": 18.0, "minimum": 16.55, "maximum": 167.9524, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "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": 29.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 18.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 18.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.67, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 158.01, "10th_percentile": 158.01, "90th_percentile": 158.01, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.68, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "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": 25.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 26.67, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.07, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 20.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.25, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.7, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.02, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.68, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.55 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.49, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ARTHREX TENODESIS REPAIR KIT", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "BENIGN PROSTATIC HYPERTROPHY WITH MCC", "code_information": [ { "code": "725", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9734.0, "minimum": 5120.7, "maximum": 17550.0, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8787.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 8787.91, "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": 15575.2, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8787.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 9051.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 9051.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 14115.03, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9403.06, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 10221.23, "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": 12654.85, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9051.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 8787.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14115.03, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8787.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11788.48, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 11681.4, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 15575.2, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 9666.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11670.69, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11435.12, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9734.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13701.7 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 8787.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 14160.59 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 8787.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8612.15, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 9734.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 10415.92, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 8854.87 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11788.48, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ASSAY IGA/IGD/IGG/IGM EACH - 82784 - 3011079", "code_information": [ { "code": "82784", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21.6, "discounted_cash": 9.0, "minimum": 2.8166, "maximum": 50.96, "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 45.82, "10th_percentile": 45.82, "90th_percentile": 45.82, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.95, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "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": 13.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 18.58, "10th_percentile": 18.58, "90th_percentile": 18.58, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.49, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 13.92, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 10.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 13.78, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 13.5, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 14.59, "10th_percentile": 14.59, "90th_percentile": 45.33, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.11, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.95, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.37 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.9, "additional_payer_notes": "149.50% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 3.12, "10th_percentile": 2.3, "90th_percentile": 7.16, "count": "20" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "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": 14.88, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 9.58, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 9.58, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.49, "additional_payer_notes": "145.00% of Medicare Rates" } ] } ] }, { "description": "Ativan", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00641604425", "type": "NDC" }, { "code": "J2060", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 53.67, "10th_percentile": 53.67, "90th_percentile": 53.67, "count": "1 through 10" } ] } ] }, { "description": "Arthrodesis subtalar", "code_information": [ { "code": "28725", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7059.42, "discounted_cash": 12086.0, "minimum": 2095.55, "maximum": 7059.42, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2200.33 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2158.42 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7059.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 7059.42, "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": 7059.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2095.55 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7059.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2137.46 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 7059.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 7059.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7059.42, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7059.42, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 7059.42, "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": 7059.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7059.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7059.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7059.42, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2095.55 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7059.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7059.42, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 7059.42, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2158.42 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 7059.42, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7059.42, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 5494.39 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7059.42, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2095.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7059.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7059.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 7059.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2200.33 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7059.42, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7059.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7059.42, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7059.42, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BENZODIAZE RFX", "code_information": [ { "code": "80347", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 105.0, "minimum": 15.12, "maximum": 734.559, "payers_information": [ { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 40.47 } ] } ] }, { "description": "ASSAY OF ARSENIC - 82175 - 3010450", "code_information": [ { "code": "82175", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 85.0, "discounted_cash": 18.0, "minimum": 4.2134, "maximum": 165.62, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 1.33, "10th_percentile": 1.33, "90th_percentile": 12.24, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 30.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.3, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 27.51, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 28.4, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 20.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 28.11, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 21.78 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.55, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.59, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.36, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT OR T-CELL IMMUNOTHERAPY- SOI : 2", "code_information": [ { "code": "0082", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 40749.613, "maximum": 43602.09, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 42787.09 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 41972.1 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 40749.61 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 42379.6 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 40749.61 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 41972.1 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 40749.61 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 40749.61 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 43602.09 } ] } ] }, { "description": "BENZODIAZEPINES CONFIRM,QUANTI", "code_information": [ { "code": "80347", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 749.55, "minimum": 15.12, "maximum": 734.559, "payers_information": [ { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 40.47 } ] } ] }, { "description": "ASSAY OF CADMIUM", "code_information": [ { "code": "82300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 77.06, "discounted_cash": 23.0, "minimum": 11.0966, "maximum": 95.8048, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 37.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 25.29, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 34.28, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 28.37, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 26.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 35.03, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 21.78 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 34.33, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.17, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.28 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.34, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT OR T-CELL IMMUNOTHERAPY- SOI : 3", "code_information": [ { "code": "0083", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 66973.93, "maximum": 71662.11, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 70322.63 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 68983.15 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 66973.93 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 69652.89 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 66973.93 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 68983.15 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 66973.93 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 66973.93 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 71662.11 } ] } ] }, { "description": "ARTHROGRAM ANKLE LEFT - 73615 - 3240018", "code_information": [ { "code": "73615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1929.4, "discounted_cash": 328.0, "minimum": 64.23, "maximum": 1890.812, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 525.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 351.43, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 476.24, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 491.67, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 394.13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 361.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 486.75, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 476.93, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 321.87, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 64.23 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 491.02, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BENZODIAZEPINES CONFIRMATION", "code_information": [ { "code": "80346", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 67.4, "minimum": 7.6723, "maximum": 237.9538, "payers_information": [ { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 40.47 } ] } ] }, { "description": "ASSAY OF FREE TESTOSTERONE", "code_information": [ { "code": "84402", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.37, "discounted_cash": 25.0, "minimum": 1.8778, "maximum": 92.4826, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 2.35, "10th_percentile": 2.35, "90th_percentile": 5.67, "count": "100" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "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": 40.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 26.23, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 26.23, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.93, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 15.03, "10th_percentile": 15.03, "90th_percentile": 15.03, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 27.25, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 26.74, "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": 35.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 89.78, "10th_percentile": 9.78, "90th_percentile": 473.72, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 14.02, "10th_percentile": 14.02, "90th_percentile": 33.81, "count": "11" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 36.93, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 38.13, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 30.56, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 28.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 37.75, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 29.56 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 36.98, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 14.87, "10th_percentile": 14.87, "90th_percentile": 35.85, "count": "23" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.96, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 27.25, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.92 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.08, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "B-hCG. QUALITATIVE", "code_information": [ { "code": "84703", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 189.6, "discounted_cash": 7.0, "minimum": 6.77, "maximum": 185.808, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.58 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 27.31, "10th_percentile": 27.3, "90th_percentile": 27.31, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.26 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "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": 12.03, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.11 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 7.75, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 7.75, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.9, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 174.81, "10th_percentile": 174.81, "90th_percentile": 174.81, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 7.9, "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": 10.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.9, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11.26, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.26 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 8.27, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11.14, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 10.92, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 172.92, "10th_percentile": 172.91, "90th_percentile": 172.92, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.58 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.37, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.77 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.24, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ARTHROGRAM ANKLE RIGHT (R)", "code_information": [ { "code": "73615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1929.4, "discounted_cash": 328.0, "minimum": 64.23, "maximum": 1890.812, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 525.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 351.43, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 476.24, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 491.67, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 394.13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 361.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 486.75, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 476.93, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 321.87, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 64.23 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 491.02, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BETA-2 GLYCOPROTEIN IgA", "code_information": [ { "code": "86146", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 61.05, "discounted_cash": 25.0, "minimum": 8.7912, "maximum": 891.8, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 17.59, "10th_percentile": 17.59, "90th_percentile": 17.59, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 40.72, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 27.23, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 36.9, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 38.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 30.54, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 28.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 37.72, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 36.96, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 107.47, "10th_percentile": 107.47, "90th_percentile": 107.47, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.94, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.91 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.05, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ASSAY OF IGE - 82785 - 3010634", "code_information": [ { "code": "82785", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 36.34, "discounted_cash": 16.0, "minimum": 3.06, "maximum": 225.4, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 5.61, "10th_percentile": 5.6, "90th_percentile": 5.61, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 26.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.61, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 19.75, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 18.11, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.39, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 23.9, "additional_payer_notes": "145.21% 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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 32.82, "10th_percentile": 32.82, "90th_percentile": 35.47, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 16.13, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.81 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.61, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "B. PERUSSIS AB IGA", "code_information": [ { "code": "86615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 65.96, "discounted_cash": 13.0, "minimum": 9.4982, "maximum": 73.451, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 10.8, "10th_percentile": 10.79, "90th_percentile": 10.8, "count": "11" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 21.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.11, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 17.99, "10th_percentile": 17.99, "90th_percentile": 17.99, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 19.13, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.83, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.51, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.55, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.15, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 68.35, "10th_percentile": 68.35, "90th_percentile": 68.35, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.93, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.72, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ARTHROGRAM ANKLE RIGHT - 73615 - 3220015", "code_information": [ { "code": "73615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1929.4, "discounted_cash": 328.0, "minimum": 64.23, "maximum": 1890.812, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 525.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 351.43, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 476.24, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 491.67, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 394.13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 361.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 486.75, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 476.93, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 321.87, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 64.23 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 491.02, "additional_payer_notes": "149.50% 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": 43864.0, "minimum": 9322.3, "maximum": 70182.432, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 39396.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 39396.4, "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": 70182.43, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 39396.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 40578.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 40578.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 63602.83, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 42154.15, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 46057.22, "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": 57023.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 40578.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 39396.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 63602.83, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 39396.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 53119.33, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 52636.82, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 70182.43, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 43336.04, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 52588.57, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 51527.06, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 43864.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 66594.3 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 39396.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 66833.82 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 39396.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 38608.47, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 43864.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 46934.5, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 43020.13 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 53119.33, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ASSAY OF PROTEIN SERUM", "code_information": [ { "code": "84155", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28.25, "discounted_cash": 3.0, "minimum": 1.1664, "maximum": 27.685, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "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": 5.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 3.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 3.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 3.85, "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": 5.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4.4, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 4.04, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5.33, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.6, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.3 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BABESIA MICROTI IGG", "code_information": [ { "code": "86753", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 54.75, "discounted_cash": 12.0, "minimum": 7.884, "maximum": 145.04, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.56 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.94 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "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": 19.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.63 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 13.01, "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": 17.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.55, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.87, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.94 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.36, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.99, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.56 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.14, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.15 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ARTHROGRAM ELBOW RIGHT - 73085 - 3220024", "code_information": [ { "code": "73085", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1929.4, "discounted_cash": 328.0, "minimum": 47.5, "maximum": 1890.812, "payers_information": [ { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 351.43, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 476.24, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 491.67, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 394.13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 361.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 486.75, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 476.93, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 321.87, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.5 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 491.02, "additional_payer_notes": "149.50% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 525.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% 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": 13008.0, "minimum": 4332.9, "maximum": 20812.864, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11723.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 11723.7, "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": 20812.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11723.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 12075.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 12075.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 18861.66, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12544.36, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 13658.44, "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": 16910.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12075.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 11723.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18861.66, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 11723.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15752.74, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 15609.65, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 20812.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 12896.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15595.34, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15280.54, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13008.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20265.6 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 11723.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 19212.76 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 11723.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11489.23, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 13008.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 13918.6, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 10872.63 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15752.74, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ASSAY OF TOTAL TESTOSTERONE", "code_information": [ { "code": "84403", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 95.63, "discounted_cash": 25.0, "minimum": 2.3472, "maximum": 93.7174, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 2.35, "10th_percentile": 2.35, "90th_percentile": 5.74, "count": "100" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "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": 41.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 26.58, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 26.58, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 37.42, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 15.03, "10th_percentile": 15.03, "90th_percentile": 15.03, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 27.62, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 27.1, "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": 36.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 14.02, "10th_percentile": 14.02, "90th_percentile": 34.26, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 37.42, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 38.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 30.97, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 28.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 38.25, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 29.56 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 37.48, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 14.87, "10th_percentile": 14.87, "90th_percentile": 36.33, "count": "23" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.29, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 27.62, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.23 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.59, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BABESIA MICROTI IGM", "code_information": [ { "code": "86753", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 54.75, "discounted_cash": 12.0, "minimum": 7.884, "maximum": 145.04, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "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": 19.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 13.01, "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": 17.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.55, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.87, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.36, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.99, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.14, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.15 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ARTHROGRAM HIP LEFT - 73525 - 3240035", "code_information": [ { "code": "73525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1929.4, "discounted_cash": 328.0, "minimum": 64.23, "maximum": 1890.812, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 525.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 351.43, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 476.24, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 491.67, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 394.13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 361.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 486.75, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 476.93, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 321.87, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 64.23 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 491.02, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BILIRUBIN,TOTAL", "code_information": [ { "code": "82247", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 33.6, "discounted_cash": 5.0, "minimum": 4.52, "maximum": 172.725, "payers_information": [ { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.02, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.44, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.29, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 87.55, "10th_percentile": 87.55, "90th_percentile": 87.55, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.92, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.52 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.5, "additional_payer_notes": "149.50% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 13.83, "10th_percentile": 4.84, "90th_percentile": 25.72, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 8.03, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.37, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.28, "additional_payer_notes": "145.00% of Medicare Rates" } ] } ] }, { "description": "ASSAY OF URINE CREATININE - 82570 - 3010581", "code_information": [ { "code": "82570", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11.47, "discounted_cash": 5.0, "minimum": 1.0786, "maximum": 894.25, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 3.73, "10th_percentile": 1.08, "90th_percentile": 3.73, "count": "14" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 8.29, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 193.62, "10th_percentile": 193.62, "90th_percentile": 193.62, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.54, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 22.27, "10th_percentile": 22.27, "90th_percentile": 22.27, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.51, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.68, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 11.47 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 191.52, "10th_percentile": 23.62, "90th_percentile": 191.52, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.66 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC", "code_information": [ { "code": "519", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16242.0, "minimum": 4201.6, "maximum": 25987.808, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14624.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 14624.4, "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": 25987.81, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14624.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 15063.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 15063.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 23551.45, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15648.11, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 17054.5, "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": 21115.09, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15063.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 14624.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23551.45, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 14624.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 19669.52, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 19490.86, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 25987.81, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 16086.84, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 19472.99, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 19079.92, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16242.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21786.8 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 14624.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 24204.42 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 14624.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14331.91, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 16242.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 17379.35, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 18062.29 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19669.52, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ARTHROGRAM KNEE LEFT (R)", "code_information": [ { "code": "73580", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1929.4, "discounted_cash": 328.0, "minimum": 51.19, "maximum": 1890.812, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 525.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 351.43, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 476.24, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 491.67, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 394.13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 361.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 486.75, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 476.93, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 321.87, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.19 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 491.02, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BIOINTACT PARATHYROID HORMONE", "code_information": [ { "code": "83970", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 228.35, "discounted_cash": 41.0, "minimum": 32.8824, "maximum": 326.34, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.06 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 47.95, "10th_percentile": 47.95, "90th_percentile": 47.96, "count": "71" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.32 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "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": 66.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.2 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.94 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 42.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 42.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 59.86, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 307.03, "10th_percentile": 307.03, "90th_percentile": 307.03, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 44.17, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 43.34, "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": 57.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 286.38, "10th_percentile": 286.38, "90th_percentile": 286.38, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 59.86, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.2 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 61.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 49.54, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.32 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 45.41, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 61.18, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 37.2 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 59.94, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 303.7, "10th_percentile": 303.7, "90th_percentile": 303.7, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.06 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.45, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 44.17, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.15 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 61.71, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ASSESS APHASIA W/INTERP & RPT", "code_information": [ { "code": "96105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 100.02, "discounted_cash": 93.0, "minimum": 30.006, "maximum": 481.2682, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 100.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.98, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": 100.02, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 100.02, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": 100.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 100.02, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 100.02, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 100.02, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 100.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 100.02, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 100.02 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 100.02, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 93.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.1, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": 100.02, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 100.02, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CCMCC", "code_information": [ { "code": "520", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12272.0, "minimum": 2626.0, "maximum": 19636.112, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11064.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 11064.1, "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": 19636.11, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11064.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 11396.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 11396.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 17795.23, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11838.59, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 12886.2, "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": 15954.34, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11396.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 11064.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17795.23, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 11064.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14862.08, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 14727.08, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 19636.11, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 12170.51, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14713.58, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14416.59, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12272.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17068.7 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 11064.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 18077.68 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 11064.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10842.82, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 12272.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 13131.65, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 10355.76 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14862.08, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ARTHROGRAM KNEE RIGHT (R)", "code_information": [ { "code": "73580", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1929.4, "discounted_cash": 328.0, "minimum": 51.19, "maximum": 1890.812, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 525.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 351.43, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 476.24, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 491.67, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 394.13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 361.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 486.75, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 476.93, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 321.87, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.19 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 491.02, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BIOMET 2.5 DRILL BIT 829029070", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "ASTHMA - SOI : 2", "code_information": [ { "code": "1412", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5340.581, "maximum": 5714.42, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 5607.61 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5500.8 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5340.58 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 5554.2 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5340.58 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 5500.8 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5340.58 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 5340.58 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5714.42 } ] } ] }, { "description": "BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM - SOI : 4", "code_information": [ { "code": "0494", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 34371.114, "maximum": 36777.09, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 36089.67 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 35402.25 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 34371.11 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 35745.96 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 34371.11 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 35402.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 34371.11 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 34371.11 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 36777.09 } ] } ] }, { "description": "ARTHROGRAM SHOULDER LEFT", "code_information": [ { "code": "73040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1929.4, "discounted_cash": 328.0, "minimum": 67.19, "maximum": 2647.1368, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 525.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 351.43, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 476.24, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 491.67, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 394.13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 361.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 486.75, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 476.93, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 321.87, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 67.19 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 491.02, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BIOMET 3.5S12 NONLOCK SCREW", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "ATHEROSCLEROSIS WITH MCC", "code_information": [ { "code": "302", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9941.0, "minimum": 3676.4, "maximum": 15906.4, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8973.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 8973.55, "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": 15906.4, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8973.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 9242.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 9242.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 14415.18, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9601.7, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 10438.58, "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": 12923.95, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9242.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 8973.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14415.18, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8973.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12039.16, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 11929.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 15906.4, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 9870.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11918.86, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11678.28, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9941.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12624.3 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 8973.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 14480.06 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 8973.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8794.08, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 9941.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 10637.41, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7173.09 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12039.16, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "BALL-TIO GUIDEWIRE2.5mmx1000mm", "code_information": [ { "code": "C1769", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 904.16, "10th_percentile": 904.16, "90th_percentile": 904.16, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 3242.16, "10th_percentile": 3242.16, "90th_percentile": 3242.16, "count": "1 through 10" } ] } ] }, { "description": "ARTHROGRAM SHOULDER RT (R)", "code_information": [ { "code": "73040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1929.4, "discounted_cash": 328.0, "minimum": 67.19, "maximum": 2647.1368, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 525.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 351.43, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 476.24, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 491.67, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 394.13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 361.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 486.75, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 476.93, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 321.87, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 67.19 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 491.02, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BIOMET BEARING #183720", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 9453.57, "10th_percentile": 9453.57, "90th_percentile": 9453.57, "count": "1 through 10" } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT OR T-CELL IMMUNOTHERAPY- SOI : 4", "code_information": [ { "code": "0084", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 89097.27, "maximum": 95334.08, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 93552.13 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 91770.19 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 89097.27 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 92661.16 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 89097.27 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 91770.19 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 89097.27 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 89097.27 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 95334.08 } ] } ] }, { "description": "BARBITURATES CONFIRMATION", "code_information": [ { "code": "80361", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 160.0, "minimum": 7.9776, "maximum": 156.8, "payers_information": [ { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 40.47 } ] } ] }, { "description": "ARTHROGRAM SHOULDER RT - 73040 - 3220050", "code_information": [ { "code": "73040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2701.16, "discounted_cash": 328.0, "minimum": 67.19, "maximum": 2647.1368, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 525.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 351.43, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 476.24, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 491.67, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 394.13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 361.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 486.75, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 476.93, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 321.87, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 67.19 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 491.02, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BIOMET DVRX WRIST PLATE", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "Automated Leukocyte Count", "code_information": [ { "code": "85048", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 32.34, "discounted_cash": 2.0, "minimum": 2.1096, "maximum": 213.2186, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 2.54, "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": 4.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 2.62, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 2.62, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3.68, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2.72, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 2.67, "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": 3.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.68, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 3.05, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2.79, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 3.76, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 11.41 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 3.69, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 198.42, "10th_percentile": 198.42, "90th_percentile": 198.42, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 2.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.49, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.72, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.29 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BARD SOFT MESH 12 X 12", "code_information": [ { "code": "C1781", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 2101.84, "10th_percentile": 1744.87, "90th_percentile": 5455.45, "count": "1 through 10" } ] } ] }, { "description": "ARTHROGRAM WRIST LEFT (R)", "code_information": [ { "code": "73115", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1929.4, "discounted_cash": 328.0, "minimum": 68.91, "maximum": 2647.1368, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 201.16 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 197.33 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 525.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 195.41 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 351.43, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 191.58 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 491.67, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 394.13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 197.33 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 361.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 486.75, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 476.93, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "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 Duals", "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": 201.16 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 321.87, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.91 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 491.02, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BIOMET FEMORAL COMP 12.5MM 21-", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 9453.57, "10th_percentile": 9453.57, "90th_percentile": 9453.57, "count": "1 through 10" } ] } ] }, { "description": "BARD VENTRALIGHT MESH 4X6", "code_information": [ { "code": "C1781", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 2101.84, "10th_percentile": 1744.87, "90th_percentile": 5455.45, "count": "1 through 10" } ] } ] }, { "description": "ARTHROGRAM WRIST LEFT - 73115 - 3220062", "code_information": [ { "code": "73115", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2701.16, "discounted_cash": 328.0, "minimum": 68.91, "maximum": 2647.1368, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 525.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 351.43, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 476.24, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 491.67, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 394.13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 361.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 486.75, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 476.93, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 321.87, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.91 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 491.02, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BIOMET GEN. 4 FEMORAL COMP.", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 9453.57, "10th_percentile": 9453.57, "90th_percentile": 9453.57, "count": "1 through 10" } ] } ] }, { "description": "BARD VENTRIO ST HERNIA PATCH", "code_information": [ { "code": "C1781", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 2101.84, "10th_percentile": 1744.87, "90th_percentile": 5455.45, "count": "1 through 10" } ] } ] }, { "description": "ARTHROGRAM WRIST RIGHT (R)", "code_information": [ { "code": "73115", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1929.4, "discounted_cash": 328.0, "minimum": 68.91, "maximum": 2647.1368, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 525.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 351.43, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 476.24, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 491.67, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 394.13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 361.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 486.75, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 476.93, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 321.87, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.91 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 491.02, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "Biomet lead cortical screw", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "B CELLS", "code_information": [ { "code": "86355", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 64.81, "discounted_cash": 37.0, "minimum": 9.3326, "maximum": 649.25, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 60.37, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 40.37, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 54.71, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 56.48, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 45.28, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 41.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 55.92, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 38.51 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 54.79, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.98, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.96 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 56.41, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BARIUM ENEMA", "code_information": [ { "code": "74270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1412.18, "discounted_cash": 165.0, "minimum": 66.94, "maximum": 1383.9364, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 264.21, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 165.13, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 176.69, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 165.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 302.61, "10th_percentile": 302.61, "90th_percentile": 302.61, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 165.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 239.44, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 247.2, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 198.16, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 181.64, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 244.72, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 239.79, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 165.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 161.83, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 66.94 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 246.87, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "AS-1 CR-CS-CEMENTED BP - C1776 - 2783165", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 9453.57, "10th_percentile": 9453.57, "90th_percentile": 9453.57, "count": "1 through 10" } ] } ] }, { "description": "BIOMET TAPERLOC FEM. 11-103204", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 9453.57, "10th_percentile": 9453.57, "90th_percentile": 9453.57, "count": "1 through 10" } ] } ] }, { "description": "B CELLS TOTAL COUNT - 86355 - 3021038", "code_information": [ { "code": "86355", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 86.55, "discounted_cash": 37.0, "minimum": 9.3326, "maximum": 649.25, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.44 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.67 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 60.37, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.51 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.28 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 40.37, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 38.51 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 56.48, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 45.28, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.67 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 41.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 55.92, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 38.51 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 54.79, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.51 }, { "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 Duals", "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": 40.44 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.98, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.96 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 56.41, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BARIUM ENEMA (SINGLE CONTRAST)", "code_information": [ { "code": "74270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1008.7, "discounted_cash": 165.0, "minimum": 66.94, "maximum": 1383.9364, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "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 Duals", "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": 201.16 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 161.83, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 66.94 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 246.87, "additional_payer_notes": "149.50% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 201.16 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 197.33 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 264.21, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 165.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 195.41 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 176.69, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 165.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 302.61, "10th_percentile": 302.61, "90th_percentile": 302.61, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 165.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 191.58 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 247.2, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 198.16, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 197.33 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 181.64, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 244.72, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 239.79, "additional_payer_notes": "145.21% of Medicare Rates" } ] } ] }, { "description": "ASCA IGG, ELSIA", "code_information": [ { "code": "83520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 311.91, "discounted_cash": 17.0, "minimum": 7.5514, "maximum": 820.064, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 17.28, "10th_percentile": 17.28, "90th_percentile": 25.72, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "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": 27.63, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.04, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 129.08, "10th_percentile": 129.08, "90th_percentile": 129.08, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.48, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 18.13, "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": 24.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 59.56, "10th_percentile": 59.56, "90th_percentile": 185.76, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 25.04, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.85, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 19.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.59, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.08, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 82.08, "10th_percentile": 82.08, "90th_percentile": 82.08, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.92, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.48, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.54 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.82, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BIOMET X-FIX ROD 9.5X 350/400", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "B. HENSELAE IgM", "code_information": [ { "code": "86611", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 53.05, "discounted_cash": 10.0, "minimum": 7.6392, "maximum": 51.989, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 16.29, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.89, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.76, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.24, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.09, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.98, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.22, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BASEPLATE TIB CMNTD SZ 7", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 9453.57, "10th_percentile": 9453.57, "90th_percentile": 9453.57, "count": "1 through 10" } ] } ] }, { "description": "ASNIS WASHER FOR 6.5/8.0MM SCR", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "BIOMET X-FIX SLM PIN-ROD CLAMP", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "BASEPLATE TRITANIUM SIZE 6", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 9453.57, "10th_percentile": 9453.57, "90th_percentile": 9453.57, "count": "1 through 10" } ] } ] }, { "description": "ASPERGILLUS ANTIBODY", "code_information": [ { "code": "86606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 64.55, "discounted_cash": 15.0, "minimum": 4.6714, "maximum": 85.6912, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 24.08, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 21.82, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 22.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 16.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 22.3, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.85, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "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": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.5, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BIOMET X-FIX SLM ROD-ROD-CLAMP", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM - SOI : 3", "code_information": [ { "code": "0493", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17241.598, "maximum": 18448.51, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 18103.68 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 17758.85 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 17241.6 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 17931.26 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 17241.6 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 17758.85 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 17241.6 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 17241.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 18448.51 } ] } ] }, { "description": "BEAST INJ. PUTTY 2.5CC", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "ASPERGILLUS FUMIGATUS #1 ABS", "code_information": [ { "code": "86606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 87.44, "discounted_cash": 15.0, "minimum": 4.6714, "maximum": 85.6912, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 24.08, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 21.82, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 22.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 16.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 22.3, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.85, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "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": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.5, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CCMCC", "code_information": [ { "code": "479", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15134.0, "minimum": 4332.9, "maximum": 24215.152, "payers_information": [ { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 14039.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 21944.98, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14584.96, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 15891.19, "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": 19674.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14039.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 13630.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 21944.98, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 13630.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18327.84, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 18161.36, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 24215.15, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 14993.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18144.72, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17778.46, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15134.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16373.6 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 13630.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 22494.55 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 13630.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13358.18, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 15134.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 16193.88, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6643.34 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18327.84, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13630.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 13630.8, "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": 24215.15, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13630.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 14039.72, "additional_payer_notes": "103.00% 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": 20782.0, "minimum": 7221.5, "maximum": 33251.536, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 18695.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 18695.9, "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": 33251.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 18695.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 19256.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 19256.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 30134.2, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20004.61, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 21821.32, "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": 27016.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19256.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 18695.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 30134.2, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 18695.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 25167.26, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 24938.65, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 33251.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 20565.49, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 24915.79, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 24412.86, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20782.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19041.6 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 18695.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 31210.9 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 18695.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18321.98, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 20782.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 22236.96, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 8472.85 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 25167.26, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "BEEF (BOS SPP) IGE", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 33.77, "discounted_cash": 5.0, "minimum": 2.3472, "maximum": 454.524, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 63.37, "10th_percentile": 4.98, "90th_percentile": 77.46, "count": "23" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 8.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 405.77, "10th_percentile": 405.77, "90th_percentile": 405.77, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 113.67, "10th_percentile": 113.67, "90th_percentile": 120.05, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 224.29, "10th_percentile": 224.29, "90th_percentile": 224.29, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.58, "additional_payer_notes": "145.21% 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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 374.82, "10th_percentile": 89.19, "90th_percentile": 401.37, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 5.12, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.7 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.8, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ASPIR/INJ JOINT/BURSA W/O US", "code_information": [ { "code": "20605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1237.4, "discounted_cash": 288.0, "minimum": 283.1906, "maximum": 2790.05, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1237.4 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1237.4 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 462.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1237.4 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 288.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1237.4 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 309.2, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 288.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 288.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 1237.4 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 432.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 346.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1237.4 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 317.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 428.25, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1237.4 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 419.61, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1237.4 }, { "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 Duals", "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": 1237.4 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 283.19, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 432.01, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BIOSURE REGEN INT SCREW 7X20MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "BARD SOFT MESH 4 X 6", "code_information": [ { "code": "C1781", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 2101.84, "10th_percentile": 1744.87, "90th_percentile": 5455.45, "count": "1 through 10" } ] } ] }, { "description": "BENZODIAZEPINES CONF", "code_information": [ { "code": "80346", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 55.4, "minimum": 7.6723, "maximum": 237.9538, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.49 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.68 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.47 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.28 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.47 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.68 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 40.47 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.47 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.49 } ] } ] }, { "description": "ASPIRATE PLEURA W/ IMAGING - 32555 - 4503076", "code_information": [ { "code": "32555", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2760.2, "discounted_cash": 590.0, "minimum": 578.7488, "maximum": 3100.05, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2760.2 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2760.2 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 944.9, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2760.2 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 590.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2760.2 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 631.9, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 590.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 590.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 2760.2 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 884.07, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 708.67, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2760.2 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 649.62, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 875.21, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2760.2 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 857.55, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2760.2 }, { "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 Duals", "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": 2760.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 578.75, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 882.89, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BITEWING X-RAY FOUR FILMS", "code_information": [ { "code": "70320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4495.9, "discounted_cash": 224.0, "minimum": 27.07, "maximum": 4405.982, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 80.09 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.57 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 359.39, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 224.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.81 }, { "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 Duals - My Care", "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": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 4145.22, "10th_percentile": 4145.22, "90th_percentile": 4145.22, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 240.34, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 224.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 224.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 325.7, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 336.26, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 269.54, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.57 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 247.08, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 332.89, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 326.17, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 4100.26, "10th_percentile": 4100.26, "90th_percentile": 4100.26, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 224.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 80.09 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 220.13, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.07 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 335.81, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BETA D GLUCAN FUNGITELL", "code_information": [ { "code": "87449", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 300.94, "discounted_cash": 11.0, "minimum": 10.5264, "maximum": 294.9212, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 10.53, "10th_percentile": 10.53, "90th_percentile": 10.53, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 19.17, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.82, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.37, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.75, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.36 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.4, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.74, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.78 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.91, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ASSAY BLD/SER CHOLESTEROL", "code_information": [ { "code": "82465", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 125.0, "discounted_cash": 4.0, "minimum": 3.92, "maximum": 122.5, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 14.02, "10th_percentile": 14.02, "90th_percentile": 25.72, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 6.96, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.65, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.31, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 4.79, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6.45, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6.32, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 88.78, "10th_percentile": 88.78, "90th_percentile": 114.0, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.26, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.92 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.5, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BLADDER CANCER FISH (UROVYSION", "code_information": [ { "code": "88120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1625.0, "discounted_cash": 160.0, "minimum": 81.59, "maximum": 1592.5, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 85.67 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 84.04 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 256.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 81.59 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 83.22 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 171.62, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 81.59 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 240.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 192.47, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 84.04 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 176.43, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 237.7, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 81.59 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 232.9, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 81.59 }, { "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 Duals", "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": 85.67 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.18, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 239.78, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BARD VENTRALIGHT MESHECHO 6X10", "code_information": [ { "code": "C1781", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 2101.84, "10th_percentile": 1744.87, "90th_percentile": 5455.45, "count": "1 through 10" } ] } ] }, { "description": "BETA LAC POS", "code_information": [ { "code": "87185", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 67.0, "discounted_cash": 4.0, "minimum": 4.28, "maximum": 220.304, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.48 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.03 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "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": 7.6, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.36 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.81 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 4.89, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 4.89, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "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": 6.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.36 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.11, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.03 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.04, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.36 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6.9, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.48 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.66, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.28 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.1, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ASSAY GLUCOSE BLOOD QNT", "code_information": [ { "code": "82947", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 125.0, "discounted_cash": 3.0, "minimum": 2.0909, "maximum": 122.5, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 9.77, "10th_percentile": 9.76, "90th_percentile": 25.72, "count": "21" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "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": 6.29, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 4.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 4.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.21, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 4.13, "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": 5.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5.88, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 4.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5.71, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 61.82, "10th_percentile": 61.82, "90th_percentile": 114.0, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.85, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.21, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.54 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.88, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BETA-2 GLYCOPROTEIN IgG", "code_information": [ { "code": "86146", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 61.05, "discounted_cash": 25.0, "minimum": 8.7912, "maximum": 891.8, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.56 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 17.59, "10th_percentile": 17.59, "90th_percentile": 17.59, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.94 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 40.72, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.63 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 27.23, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 31.01 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 38.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 30.54, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.94 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 28.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 37.72, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 36.96, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 107.47, "10th_percentile": 107.47, "90th_percentile": 107.47, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 32.56 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.94, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.91 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.05, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ASSAY GLUTAMYLTRASE GAMMA", "code_information": [ { "code": "82977", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 125.0, "discounted_cash": 7.0, "minimum": 6.48, "maximum": 122.5, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 17.57, "10th_percentile": 17.57, "90th_percentile": 17.57, "count": "133" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "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": 11.52, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 7.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 7.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.44, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 112.48, "10th_percentile": 112.48, "90th_percentile": 112.48, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.7, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 7.56, "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": 10.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 104.92, "10th_percentile": 104.92, "90th_percentile": 104.92, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 104.92, "10th_percentile": 104.92, "90th_percentile": 104.92, "count": "15" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.44, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 10.78, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.64, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 7.92, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 10.67, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 10.46, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 111.26, "10th_percentile": 111.26, "90th_percentile": 111.26, "count": "21" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.06, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.7, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.48 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.76, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BLOOD DRUGS OF ABUSE, 6", "code_information": [ { "code": "80307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 290.64, "discounted_cash": 62.0, "minimum": 2.9664, "maximum": 1127.0, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 99.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": 90.1, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 66.49, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": 87.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 14.17, "10th_percentile": 14.17, "90th_percentile": 17.72, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 90.1, "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 93.02, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 74.57, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 68.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 92.09, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 46.78 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 90.23, "additional_payer_notes": "145.21% 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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.9, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.93 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 92.9, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BCR-ABL1 TRANSCRIPT DETECTION - 81206 - 3003589", "code_information": [ { "code": "81206", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 250.0, "discounted_cash": 163.0, "minimum": 36.0, "maximum": 250.0, "payers_information": [ { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 175.44, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 156.48 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 245.45, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 196.75, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 161.17 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 180.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 242.99, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 156.48 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 238.09, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 156.48 }, { "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 Duals", "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": 164.3 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.68, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 147.56 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 245.12, "additional_payer_notes": "149.50% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 164.3 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 161.17 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 250.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 156.48 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 159.61 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 168.88, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BETA-2 GLYCOPROTEIN IgM", "code_information": [ { "code": "86146", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 61.05, "discounted_cash": 25.0, "minimum": 8.7912, "maximum": 891.8, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 17.59, "10th_percentile": 17.59, "90th_percentile": 17.59, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 40.72, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 27.23, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 36.9, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 38.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 30.54, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 28.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 37.72, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 36.96, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 107.47, "10th_percentile": 107.47, "90th_percentile": 107.47, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.94, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.91 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.05, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ASSAY HAPTOGLOBIN QNT", "code_information": [ { "code": "83010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 125.0, "discounted_cash": 12.0, "minimum": 2.6424, "maximum": 154.154, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 18.0, "10th_percentile": 12.14, "90th_percentile": 25.72, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "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": 20.13, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.96, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 12.96, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.24, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 16.92, "10th_percentile": 16.92, "90th_percentile": 16.92, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.46, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 13.21, "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": 17.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.24, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.83, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.1, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.27, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 114.0, "10th_percentile": 114.0, "90th_percentile": 114.0, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.33, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.46, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.32 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.81, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BODY FLUID SPECIFIC GRAVITY - 84315 - 3001421", "code_information": [ { "code": "84315", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 52.55, "discounted_cash": 3.0, "minimum": 2.95, "maximum": 246.715, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "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": 5.25, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 3.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 3.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3.51, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 3.44, "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": 4.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4.91, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 3.94, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.21, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.51, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.95 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.9, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BETALAC NEG", "code_information": [ { "code": "87185", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 67.0, "discounted_cash": 4.0, "minimum": 4.28, "maximum": 220.304, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "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": 7.6, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 4.89, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 4.89, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "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": 6.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.11, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.04, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.36 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6.9, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.66, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.28 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.1, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ASSAY IGA/IGD/IGG/IGM EACH - 82784 - 3011225", "code_information": [ { "code": "82784", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28.25, "discounted_cash": 9.0, "minimum": 2.8166, "maximum": 50.96, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 3.12, "10th_percentile": 2.3, "90th_percentile": 7.16, "count": "20" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "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": 14.88, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 9.58, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 9.58, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.49, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 45.82, "10th_percentile": 45.82, "90th_percentile": 45.82, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.95, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "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": 13.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 18.58, "10th_percentile": 18.58, "90th_percentile": 18.58, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.49, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 13.92, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 10.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 13.78, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 13.5, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 14.59, "10th_percentile": 14.59, "90th_percentile": 45.33, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.11, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.95, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.37 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.9, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BODY FLUID TOTAL PROTEIN", "code_information": [ { "code": "84157", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9.0, "discounted_cash": 4.0, "minimum": 1.296, "maximum": 61.74, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "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": 6.4, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 4.12, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 4.12, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 4.2, "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": 5.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 4.4, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5.93, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 9.0 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5.81, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.92, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.6 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.98, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BEHAVIORAL DISORDERS - SOI : 1", "code_information": [ { "code": "7581", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14192.614, "maximum": 15186.1, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 14902.24 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 14618.39 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 14192.61 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 14760.32 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 14192.61 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 14618.39 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 14192.61 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 14192.61 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 15186.1 } ] } ] }, { "description": "BG LOCKING SCREW 2.5 X 12MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "ASSAY NEPHELOMETRY NES", "code_information": [ { "code": "83883", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 125.0, "discounted_cash": 13.0, "minimum": 8.208, "maximum": 166.6588, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 25.72, "10th_percentile": 13.13, "90th_percentile": 41.91, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "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": 21.76, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 14.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 14.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 14.28, "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": 19.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 19.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.36, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 16.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.96, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.16, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.75, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 114.0, "10th_percentile": 114.0, "90th_percentile": 114.0, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.33, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.24 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.33, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "Bone biopsy open superficial", "code_information": [ { "code": "20240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5273.74, "discounted_cash": 2734.0, "minimum": 1582.122, "maximum": 5273.74, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3699.71 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3629.24 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 4375.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3523.53 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2734.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3594.0 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2926.03, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2734.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2734.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 3523.53 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4093.71, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 3281.53, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3629.24 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3008.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4052.69, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1815.06 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 3970.93, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3523.53 }, { "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 Duals", "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": 3699.71 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2679.92, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4088.24, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "Benadryl", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "63323066401", "type": "NDC" }, { "code": "J1200", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 0.66, "10th_percentile": 0.66, "90th_percentile": 0.76, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 8.92, "10th_percentile": 8.92, "90th_percentile": 8.92, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 8.32, "10th_percentile": 8.32, "90th_percentile": 8.32, "count": "21" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 8.83, "10th_percentile": 8.83, "90th_percentile": 8.83, "count": "37" } ] } ] }, { "description": "BG NON-LOCKING SCREW 2.5 X 10M", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "ASSAY OF APOLIPOPROTEIN", "code_information": [ { "code": "82172", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 125.0, "discounted_cash": 21.0, "minimum": 3.456, "maximum": 209.3378, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 18.0, "10th_percentile": 16.49, "90th_percentile": 25.72, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 33.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 22.13, "10th_percentile": 22.13, "90th_percentile": 22.13, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 22.57, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 30.58, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.57, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 25.31, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 23.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.26, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 30.62, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 114.0, "10th_percentile": 114.0, "90th_percentile": 114.0, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.53, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "Bone biopsy trocarndl deep", "code_information": [ { "code": "20225", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1534.62, "discounted_cash": 1554.0, "minimum": 460.386, "maximum": 1534.62, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1534.62 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1534.62 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1534.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 1534.62, "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": 1534.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1534.62 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1534.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1534.62 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 1534.62, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 1534.62, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1534.62, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1534.62, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 1534.62, "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": 1534.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1534.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1534.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1534.62, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1534.62 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1534.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1534.62, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1534.62, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1534.62 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1534.62, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1534.62, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1534.62 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1534.62, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1534.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1534.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1534.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 1534.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1534.62 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1523.77, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1534.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1534.62, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1534.62, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BENZENE", "code_information": [ { "code": "84600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 77.6, "discounted_cash": 17.0, "minimum": 11.1744, "maximum": 76.048, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.6 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.11 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.11, "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": 27.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.87 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.62, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 17.62, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.81, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.31, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "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": 23.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 24.81, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.61, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.53, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.11 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 18.82, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.36, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.85, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.31, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.4 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.58, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BILAT 1-2 LVL DOPPLER WAVEFORM", "code_information": [ { "code": "93922", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 745.36, "discounted_cash": 125.0, "minimum": 122.745, "maximum": 730.4528, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.81 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.19 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 200.4, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 131.25 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 133.88 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 134.02, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 131.25 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 150.3, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.19 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 137.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 185.62, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 131.25 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 181.88, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 131.25 }, { "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 Duals", "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": 137.81 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 122.75, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 187.25, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ASSAY OF IGE - 82785 - 3010630", "code_information": [ { "code": "82785", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 35.99, "discounted_cash": 16.0, "minimum": 3.06, "maximum": 225.4, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 5.61, "10th_percentile": 5.6, "90th_percentile": 5.61, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 26.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.61, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 19.75, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 18.11, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.39, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 23.9, "additional_payer_notes": "145.21% 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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 32.82, "10th_percentile": 32.82, "90th_percentile": 35.47, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 16.13, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.81 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.61, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BONE DISEASES AND ARTHROPATHIES WITH MCC", "code_information": [ { "code": "553", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10723.0, "minimum": 5383.3, "maximum": 18450.0, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 9674.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9481.14, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 10723.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 11473.85, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 9157.71 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12985.82, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9674.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 9674.63, "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": 17157.15, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9674.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 9964.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 9964.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 15548.67, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10351.85, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 11259.38, "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": 13940.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9964.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 9674.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15548.67, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 9674.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12985.82, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 12867.86, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 17157.15, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 10642.09, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12856.07, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12596.57, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10723.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14172.9 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 9674.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 15686.53 } ] } ] }, { "description": "BETA 2 MICROGLOBULIN", "code_information": [ { "code": "82232", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16.0, "discounted_cash": 16.0, "minimum": 2.304, "maximum": 31.36, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "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": 16.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "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": 16.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.86, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BILE ACIDS TOTAL", "code_information": [ { "code": "82239", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16.0, "discounted_cash": 17.0, "minimum": 2.304, "maximum": 16.0, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "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": 16.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "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": 16.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ASSAY OF LEAD", "code_information": [ { "code": "83655", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40.31, "discounted_cash": 12.0, "minimum": 2.3472, "maximum": 205.8, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 2.7, "10th_percentile": 2.35, "90th_percentile": 6.38, "count": "16" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "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": 19.38, "additional_payer_notes": "160.00% 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": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.56, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.96, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 12.72, "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": 16.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.56, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.13, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.53, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.95, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 21.78 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.58, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 14.87, "10th_percentile": 14.87, "90th_percentile": 31.97, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.87, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.96, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.9 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.1, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BONE MARROW IMAGING; LTD AREA", "code_information": [ { "code": "78102", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1943.4, "discounted_cash": 376.0, "minimum": 86.87, "maximum": 1904.532, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 439.13 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 430.77 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 376.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 376.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 602.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 418.22 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 376.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 426.58 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 387.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 387.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 545.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 402.71, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 395.18, "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": 526.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 376.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 376.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 545.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 418.22 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 376.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 563.41, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 451.63, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 430.77 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 414.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 557.77, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 418.22 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 546.51, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 418.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 376.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 376.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 376.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 439.13 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.83, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 376.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 402.71, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 86.87 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 562.66, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BG NON-LOCKING SCREW 2.5 X 12M", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "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": 28516.0, "minimum": 9847.5, "maximum": 57020.2, "payers_information": [ { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 34188.31, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 33498.22, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28516.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 57020.2 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 25632.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 43147.33 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 25632.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 25119.56, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 28516.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 30512.55, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 24544.07 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 34533.36, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 25632.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 25632.2, "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": 45626.24, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25632.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 26401.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 26401.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 41348.78, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27426.45, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 29942.22, "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": 37071.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 26401.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 25632.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 41348.78, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 25632.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 34533.36, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 34219.68, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 45626.24, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 28195.42, "additional_payer_notes": "110.00% of Medicare Rates" } ] } ] }, { "description": "ASSAY OF MERCURY", "code_information": [ { "code": "83825", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 54.12, "discounted_cash": 16.0, "minimum": 3.6144, "maximum": 159.9164, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.87 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 8.92, "10th_percentile": 1.33, "90th_percentile": 12.24, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.43 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "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": 26.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.78 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.22 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.75, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 16.75, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.58, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.4, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 17.07, "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": 22.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 23.58, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.34, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 19.51, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.43 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 17.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.1, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 21.78 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 23.61, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.78 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.87 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.93, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.4, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.63 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.31, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BONE SCREW FULL THREAD 3.5MM X - C1713 - 2783137", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "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": 21415.0, "minimum": 2888.6, "maximum": 34265.2, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 19264.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 19264.0, "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": 34265.2, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 19264.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 19841.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 19841.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 31052.84, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20612.48, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 22486.54, "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": 27840.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19841.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 19264.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 31052.84, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 19264.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 25934.47, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 25698.9, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 34265.2, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 21190.4, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 25675.34, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 25157.08, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21415.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23231.8 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 19264.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 32188.66 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 19264.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18878.72, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 21415.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 22914.85, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 19895.03 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 25934.47, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "BIO X-FIX CORTICAL SCREWSSD50", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "ASSAY OF TRIGLYCERIDES", "code_information": [ { "code": "84478", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 125.0, "discounted_cash": 5.0, "minimum": 1.296, "maximum": 122.5, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 1.3, "10th_percentile": 1.3, "90th_percentile": 1.3, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "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": 9.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 5.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.32, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.14, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "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": 8.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.32, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6.31, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8.51, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8.34, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 8.21, "10th_percentile": 8.21, "90th_percentile": 8.21, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.63, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.14, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.17 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.58, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BONE SCREW T10 3.5X55MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "BILE ACIDS FRACTIONATED AND TO", "code_information": [ { "code": "82542", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1105.0, "discounted_cash": 24.0, "minimum": 13.68, "maximum": 1960.0, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 112.32, "10th_percentile": 112.32, "90th_percentile": 159.12, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 38.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 25.78, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 36.06, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 28.91, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 26.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 35.7, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 34.98, "additional_payer_notes": "145.21% 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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 376.2, "10th_percentile": 376.2, "90th_percentile": 376.2, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 23.61, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.68 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.01, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "ASSAY OF URINE CREATININE - 82570 - 3010591", "code_information": [ { "code": "82570", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26.47, "discounted_cash": 5.0, "minimum": 1.0786, "maximum": 894.25, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 3.73, "10th_percentile": 1.08, "90th_percentile": 3.73, "count": "14" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 8.29, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 193.62, "10th_percentile": 193.62, "90th_percentile": 193.62, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.54, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 22.27, "10th_percentile": 22.27, "90th_percentile": 22.27, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.51, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.68, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 191.52, "10th_percentile": 23.62, "90th_percentile": 191.52, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.66 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BONE SCREW T10 3.5X60MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "BILIRUBIN TOTAL - 82247 - 3001380", "code_information": [ { "code": "82247", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 96.0, "discounted_cash": 5.0, "minimum": 4.52, "maximum": 172.725, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.58 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 13.83, "10th_percentile": 4.84, "90th_percentile": 25.72, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.26 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 8.03, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.11 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.37, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 15.79 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.02, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.26 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.44, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.29, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 87.55, "10th_percentile": 87.55, "90th_percentile": 87.55, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.58 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.92, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.52 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.5, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BIOMENT SHELL 11-106056", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 9453.57, "10th_percentile": 9453.57, "90th_percentile": 9453.57, "count": "1 through 10" } ] } ] }, { "description": "ASSAY OF URINE CREATININE - 82570 - 3010600", "code_information": [ { "code": "82570", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7.49, "discounted_cash": 5.0, "minimum": 1.0786, "maximum": 894.25, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 3.73, "10th_percentile": 1.08, "90th_percentile": 3.73, "count": "14" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 7.49, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": 7.49, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 193.62, "10th_percentile": 193.62, "90th_percentile": 193.62, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.54, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 22.27, "10th_percentile": 22.27, "90th_percentile": 22.27, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.49, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.49, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.49, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 7.49 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.49, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 191.52, "10th_percentile": 23.62, "90th_percentile": 191.52, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.66 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.49, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BONE SCREW T10 F-T 3.5MM/60MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "BILIRUBIN TOTAL - 82247 - 3066321", "code_information": [ { "code": "82247", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 125.0, "discounted_cash": 5.0, "minimum": 4.52, "maximum": 172.725, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 13.83, "10th_percentile": 4.84, "90th_percentile": 25.72, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 8.03, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.37, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.28, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.02, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.44, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.29, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 87.55, "10th_percentile": 87.55, "90th_percentile": 87.55, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.92, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.52 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.5, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BIOMET 2.0MM K WIRE #141796", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "ASSAY OF URINE CREATININE - 82570 - 3011202", "code_information": [ { "code": "82570", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 912.5, "discounted_cash": 5.0, "minimum": 1.0786, "maximum": 894.25, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 30.24, "10th_percentile": 30.24, "90th_percentile": 30.24, "count": "115" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 8.29, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 193.62, "10th_percentile": 193.62, "90th_percentile": 193.62, "count": "28" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.54, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 180.6, "10th_percentile": 180.6, "90th_percentile": 180.6, "count": "18" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.51, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.68, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 191.52, "10th_percentile": 191.52, "90th_percentile": 191.52, "count": "20" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.66 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BONE SCREW T10 FT 3.5MM/L26", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "BILIRUBIN_ DIRECT", "code_information": [ { "code": "82248", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 96.0, "discounted_cash": 5.0, "minimum": 4.52, "maximum": 94.08, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.58 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 13.82, "10th_percentile": 13.82, "90th_percentile": 13.83, "count": "19" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.26 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 8.03, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.11 }, { "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 Duals - My Care", "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": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 177.02, "10th_percentile": 177.02, "90th_percentile": 177.02, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.37, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 82.56, "10th_percentile": 82.56, "90th_percentile": 165.12, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 15.79 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.02, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.26 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.44, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.29, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 87.55, "10th_percentile": 87.55, "90th_percentile": 175.1, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.58 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.92, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.52 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.5, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BIOMET 4.5 NOLOCKING BONESCREW", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "ASSAY THREE CATECHOLAMINES", "code_information": [ { "code": "82384", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 55.97, "discounted_cash": 25.0, "minimum": 8.0597, "maximum": 78.841, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 40.4, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 27.02, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 33.97, "10th_percentile": 33.97, "90th_percentile": 33.97, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 37.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 30.3, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 27.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 37.42, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 29.56 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 36.67, "additional_payer_notes": "145.21% 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 Duals", "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": 24.75, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.73 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.75, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BONE SCREW T10 FULL THREAD 3.5 - C1713 - 2782201", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "BIOFEEDBACK TRAIN ANY MODALITY", "code_information": [ { "code": "90901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 191.45, "discounted_cash": 16.0, "minimum": 15.8466, "maximum": 187.621, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 172.18 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 168.9 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 25.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 163.98 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 167.26 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 163.98 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.21, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 168.9 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 23.96, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 163.98 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 23.48, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 163.98 }, { "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 Duals", "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": 172.18 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.85, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.17, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BIOMET ACETABULAR BONE SCREW", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "ASTHMA - SOI : 1", "code_information": [ { "code": "1411", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4368.61, "maximum": 4674.41, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 4587.04 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4499.67 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4368.61 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 4543.35 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4368.61 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 4499.67 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4368.61 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 4368.61 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4674.41 } ] } ] }, { "description": "BONE SCREW T10 FULL THREAD 3.5 - C1713 - 2782202", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "BIOMENT LINER EP-105924", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 9453.57, "10th_percentile": 9453.57, "90th_percentile": 9453.57, "count": "1 through 10" } ] } ] }, { "description": "BIOMET DVR ANATOMIC NARROW SHO", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "ASTHMA - SOI : 4", "code_information": [ { "code": "1414", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9669.041, "maximum": 10345.87, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 10152.49 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 9959.11 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 9669.04 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 10055.8 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 9669.04 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 9959.11 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9669.04 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 9669.04 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10345.87 } ] } ] }, { "description": "BONE SCREW T6 2.3MMX14MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "BIOMET 4.5 LOCKING BONE SCREW", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "BIOMET ENDO HEAD 12-139014", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 9453.57, "10th_percentile": 9453.57, "90th_percentile": 9453.57, "count": "1 through 10" } ] } ] }, { "description": "ATOPOBIUM BAGINAE", "code_information": [ { "code": "87798", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 112.5, "discounted_cash": 35.0, "minimum": 4.6512, "maximum": 646.8, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 34.32, "10th_percentile": 4.65, "90th_percentile": 48.6, "count": "16" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 56.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.55, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 183.27, "10th_percentile": 183.27, "90th_percentile": 191.25, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 26.87, "10th_percentile": 26.87, "90th_percentile": 290.25, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 42.11, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 38.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.0, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 45.17 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 50.95, "additional_payer_notes": "145.21% 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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 114.0, "10th_percentile": 29.46, "90th_percentile": 307.8, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 34.39, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.58 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.46, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BONE SCREW T6 2.3MMX16MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "BIOMET ACETABULAR CUP", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 9453.57, "10th_percentile": 9453.57, "90th_percentile": 9453.57, "count": "1 through 10" } ] } ] }, { "description": "BIOMET MULTI DIRECTIONAL SCREW - C1713 - 4829590", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "ATYPICAL P-ANCA", "code_information": [ { "code": "86256", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14.88, "discounted_cash": 12.0, "minimum": 2.1427, "maximum": 494.9, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 14.88, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": 14.88, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.89, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": 14.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 12.8, "10th_percentile": 12.8, "90th_percentile": 25.59, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.88, "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.88, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.88, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 14.88 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.88, "additional_payer_notes": "145.21% 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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 13.57, "10th_percentile": 13.57, "90th_percentile": 27.14, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 11.81, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.85 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.88, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BONE SCREW T8 2.4 X 24MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "Biomet locking peg 2.2 1312270", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "BIOMET MULTI DIRECTIONAL SCREW - C1713 - 4829591", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "ATYPICAL PANCA", "code_information": [ { "code": "86256", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 59.5, "discounted_cash": 12.0, "minimum": 2.1427, "maximum": 494.9, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 19.28, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.89, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 12.8, "10th_percentile": 12.8, "90th_percentile": 25.59, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.86, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.5, "additional_payer_notes": "145.21% 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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 13.57, "10th_percentile": 13.57, "90th_percentile": 27.14, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 11.81, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.85 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.01, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BONE SCREW T8 FT 2.7MM/L18MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "BIOMET LOW PROF CORTICAL SCREW", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "BIOMET SSK TIBIA AUGMENT COMPO", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 9453.57, "10th_percentile": 9453.57, "90th_percentile": 9453.57, "count": "1 through 10" } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT OR T-CELL IMMUNOTHERAPY- SOI : 1", "code_information": [ { "code": "0081", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 40749.613, "maximum": 43602.09, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 42787.09 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 41972.1 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 40749.61 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 42379.6 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 40749.61 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 41972.1 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 40749.61 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 40749.61 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 43602.09 } ] } ] }, { "description": "BONE SCREW T8 FT 2.7MM/L22MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "BIOMET SMALL BONE FIXATION NAI", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "BIOMET TIBIAL REVISION", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 9453.57, "10th_percentile": 9453.57, "90th_percentile": 9453.57, "count": "1 through 10" } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT WITH CCMCC", "code_information": [ { "code": "016", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 47052.0, "minimum": 21401.9, "maximum": 75284.608, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 42256.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 42256.3, "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": 75284.61, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 42256.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 43523.99, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 43523.99, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 68226.68, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 45214.24, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 49405.52, "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": 61168.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 43523.99, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 42256.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 68226.68, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 42256.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 56981.04, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 56463.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 75284.61, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 46481.93, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 56411.7, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 55273.02, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 47052.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 49106.2 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 42256.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 71755.3 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 42256.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 41411.17, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 47052.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 50346.58, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 27778.75 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 56981.04, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "BONE SCREW T8 FULL THREAD 2.4m - C1713 - 2783159", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "BIOMET SMALL BONE FIXATION SYS", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "AUTOMATED RBC COUNT", "code_information": [ { "code": "85041", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6.44, "discounted_cash": 3.0, "minimum": 1.0, "maximum": 19.1786, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 3.02, "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": 4.83, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 3.11, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 3.11, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.38, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 5.94, "10th_percentile": 5.94, "90th_percentile": 5.94, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3.23, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "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": 4.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.38, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 3.62, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4.48, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 6.44 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4.39, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 3.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.96, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.23, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.72 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.51, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BONE SCRW T10 FULL 3.5MM/L12MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "Biomet Troch. Nail", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "BIOPSY NEEDLE GUIDE, BARD", "code_information": [ { "code": "C1819", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3296.88, "10th_percentile": 3296.88, "90th_percentile": 6593.75, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 7432.02, "10th_percentile": 7432.02, "90th_percentile": 7432.02, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 3940.7, "10th_percentile": 3940.7, "90th_percentile": 3940.7, "count": "1 through 10" } ] } ] }, { "description": "B. PERTUSSIS AB IgM", "code_information": [ { "code": "86615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 74.95, "discounted_cash": 13.0, "minimum": 9.4982, "maximum": 73.451, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.56 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 10.8, "10th_percentile": 10.79, "90th_percentile": 10.8, "count": "11" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.94 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 21.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.63 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.11, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 17.99, "10th_percentile": 17.99, "90th_percentile": 17.99, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 31.01 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.83, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.94 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.51, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.55, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.15, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 68.35, "10th_percentile": 68.35, "90th_percentile": 68.35, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 32.56 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.93, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.72, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [ { "code": "478", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19841.0, "minimum": 6827.6, "maximum": 31746.096, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 17852.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 17852.0, "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": 31746.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17852.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 18387.56, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 18387.56, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 28769.9, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19101.64, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 20833.38, "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": 25793.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18387.56, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 17852.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 28769.9, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 17852.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 24027.83, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 23809.57, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 31746.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 19637.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 23787.75, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 23307.59, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19841.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19486.4 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 17852.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 29758.78 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 17852.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17494.96, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 19841.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 21230.2, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 9416.84 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 24027.83, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "BIOSTEON SCREW 6MM X 23MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "B. QUINTATA IgM", "code_information": [ { "code": "86611", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 53.05, "discounted_cash": 10.0, "minimum": 7.6392, "maximum": 51.989, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 16.29, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.89, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.76, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.24, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.09, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.98, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.22, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BRAC 1&2 COM DUP", "code_information": [ { "code": "81211", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4874.81, "discounted_cash": 2178.0, "minimum": 147.3368, "maximum": 5429.5234, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2178.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 2178.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3484.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2178.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 2243.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 2243.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3158.16, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2330.5, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 2286.94, "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": 3049.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2178.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2178.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3158.16, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2178.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 3260.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2613.65, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2395.84, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 3227.86, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 147.34 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 3162.73, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2178.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2178.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 2178.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2134.48, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2178.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2330.5, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3256.17, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BIOPSY GUN TEMNO - C1819 - 2729852", "code_information": [ { "code": "C1819", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3296.88, "10th_percentile": 3296.88, "90th_percentile": 6593.75, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 7432.02, "10th_percentile": 7432.02, "90th_percentile": 7432.02, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 3940.7, "10th_percentile": 3940.7, "90th_percentile": 3940.7, "count": "1 through 10" } ] } ] }, { "description": "BIOSURE REGEN INT SCRW 8X20MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "B.PERTUSSIS B.PARAPERTUSSIS PC", "code_information": [ { "code": "87798", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 324.0, "discounted_cash": 35.0, "minimum": 4.6512, "maximum": 646.8, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 56.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.55, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 42.11, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 38.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.0, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 45.17 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 50.95, "additional_payer_notes": "145.21% 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 Duals", "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": 34.39, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.58 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.46, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BRCA 1 & 2", "code_information": [ { "code": "81211", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5540.33, "discounted_cash": 2178.0, "minimum": 147.3368, "maximum": 5429.5234, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 154.71 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 151.76 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2178.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 2178.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3484.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 147.34 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2178.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 150.29 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 2243.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 2243.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3158.16, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2330.5, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 2286.94, "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": 3049.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2178.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2178.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3158.16, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 147.34 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2178.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 3260.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2613.65, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 151.76 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2395.84, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 3227.86, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 147.34 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 3162.73, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 147.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2178.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2178.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 2178.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 154.71 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2134.48, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2178.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2330.5, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3256.17, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BIPOLAR DISORDERS - SOI : 2", "code_information": [ { "code": "7532", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8127.915, "maximum": 8696.87, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 8534.31 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 8371.75 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 8127.92 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 8453.03 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 8127.92 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 8371.75 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8127.92 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 8127.92 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8696.87 } ] } ] }, { "description": "BIPOLAR DISORDERS - SOI : 4", "code_information": [ { "code": "7534", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 30950.785, "maximum": 33117.34, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 32498.32 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 31879.31 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 30950.79 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 32188.82 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 30950.79 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 31879.31 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 30950.79 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 30950.79 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 33117.34 } ] } ] }, { "description": "BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM - SOI : 2", "code_information": [ { "code": "0492", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14053.247, "maximum": 15036.97, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 14755.91 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 14474.84 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 14053.25 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 14615.38 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 14053.25 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 14474.84 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 14053.25 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 14053.25 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 15036.97 } ] } ] }, { "description": "BRCA 1&2 VARIANCE", "code_information": [ { "code": "81213", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2994.1, "discounted_cash": 581.0, "minimum": 147.3368, "maximum": 2934.218, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 154.71 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 151.76 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 581.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 581.26, "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": 930.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 147.34 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 581.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 150.29 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 598.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 598.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 842.83, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 621.95, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 610.32, "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": 813.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 581.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 581.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 842.83, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 147.34 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 581.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 870.15, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 697.51, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 151.76 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 639.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 861.43, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 147.34 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 844.05, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 147.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 581.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 581.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 581.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 154.71 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 569.63, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 581.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 621.95, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 868.98, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BIPOLAR DISORDERS - SOI : 3", "code_information": [ { "code": "7533", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12013.998, "maximum": 12854.98, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 12614.7 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 12374.42 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 12014.0 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 12494.56 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 12014.0 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 12374.42 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12014.0 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 12014.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12854.98 } ] } ] }, { "description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC", "code_information": [ { "code": "094", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28154.0, "minimum": 10372.7, "maximum": 45046.64, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 25307.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 25307.3, "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": 45046.64, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25307.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 26066.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 26066.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 40823.52, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27078.81, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 29561.86, "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": 36600.4, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 26066.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 25307.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 40823.52, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 25307.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 34094.68, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 33784.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 45046.64, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 27838.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 33754.01, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 33072.68, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28154.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32260.3 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 25307.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 42588.26 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 25307.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24801.15, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 28154.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 30124.94, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 18535.89 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 34094.68, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "BREAST PROCEDURES EXCEPT MASTECTOMY - SOI : 3", "code_information": [ { "code": "3633", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 22724.554, "maximum": 24315.27, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 23860.78 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 23406.29 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 22724.55 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 23633.54 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 22724.55 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 23406.29 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 22724.55 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 22724.55 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 24315.27 } ] } ] }, { "description": "BIPOLAR HEAD COMPONENT", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 9453.57, "10th_percentile": 9453.57, "90th_percentile": 9453.57, "count": "1 through 10" } ] } ] }, { "description": "BLASTOMYCES ANTIBODY", "code_information": [ { "code": "86612", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 64.55, "discounted_cash": 12.0, "minimum": 7.0387, "maximum": 63.259, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 20.64, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.8, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.71, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.48, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.12, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.73, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.64, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.29, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BALL-TIO GUIDEWIRE 3.2mmx350mm", "code_information": [ { "code": "C1769", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 904.16, "10th_percentile": 904.16, "90th_percentile": 904.16, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 3242.16, "10th_percentile": 3242.16, "90th_percentile": 3242.16, "count": "1 through 10" } ] } ] }, { "description": "BK VIRUS QUANTITATION", "code_information": [ { "code": "87799", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 375.0, "discounted_cash": 42.0, "minimum": 38.56, "maximum": 367.5, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 68.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 45.84, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 62.12, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 64.13, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 51.41, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 47.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 63.49, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 45.17 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 62.21, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.98, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.56 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 64.05, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BNDG OPTFM GNTL SIL FM 3 3X3IN - A6212 - 2709885", "code_information": [ { "code": "A6212", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 20.49, "10th_percentile": 20.49, "90th_percentile": 62.15, "count": "1 through 10" } ] } ] }, { "description": "BARBITURATE CONFIRMATION,UR", "code_information": [ { "code": "80345", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 55.4, "minimum": 7.9776, "maximum": 102.9, "payers_information": [ { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 40.47 } ] } ] }, { "description": "BRIVARACETAM", "code_information": [ { "code": "80299", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 175.0, "discounted_cash": 18.0, "minimum": 4.6944, "maximum": 1425.9, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 29.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.94, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 27.03, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.9, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.37, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 20.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.62, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.07, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.27, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.78 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.87, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BLADD IRRIG,SMPLE,LAV,INSTALL", "code_information": [ { "code": "51700", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1157.1, "discounted_cash": 235.0, "minimum": 66.735, "maximum": 1133.958, "payers_information": [ { "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 Duals", "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": 70.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.51, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 351.64, "additional_payer_notes": "149.50% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.08 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.74 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 376.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 66.74 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.07 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 251.67, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 66.74 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 352.11, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 282.25, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.74 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 258.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 348.58, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 66.74 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 341.55, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 66.74 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.21, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BNDG OPTFM GNTL SIL FM 3 3X3IN - A6212 - 2725020", "code_information": [ { "code": "A6212", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 20.49, "10th_percentile": 20.49, "90th_percentile": 62.15, "count": "1 through 10" } ] } ] }, { "description": "BARBITURATE RFX", "code_information": [ { "code": "80345", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 105.0, "minimum": 7.9776, "maximum": 102.9, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.49 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.68 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.47 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.28 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.47 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.68 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 40.47 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.47 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.49 } ] } ] }, { "description": "BRONCHITIS AND ASTHMA WITHOUT CCMCC", "code_information": [ { "code": "203", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5812.0, "minimum": 1972.2, "maximum": 9450.0, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 5270.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 5270.55, "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": 9300.03, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5270.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 5428.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 5428.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 8428.15, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5639.49, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 6103.15, "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": 7556.28, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5428.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 5270.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8428.15, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 5270.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7038.96, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 6975.02, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 9300.03, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 5797.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6968.63, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6827.97, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5812.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4622.31 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 5270.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 8107.67 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 5270.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5165.14, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 5812.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 6219.4, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 1972.2 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7038.96, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "BLADDER IRRIGATION, SIMPLE", "code_information": [ { "code": "51700", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1157.1, "discounted_cash": 235.0, "minimum": 66.735, "maximum": 1133.958, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 376.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.21, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 251.67, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 352.11, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 282.25, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 258.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 348.58, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 66.74 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 341.55, "additional_payer_notes": "145.21% 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 Duals", "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": 230.51, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 351.64, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BODY FLUID GLUCOSE", "code_information": [ { "code": "82945", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9.0, "discounted_cash": 3.0, "minimum": 1.296, "maximum": 42.042, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.0 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.0 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "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": 6.29, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.0 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.0 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 4.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 4.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.21, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 4.13, "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": 5.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.0 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5.88, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.0 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 4.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 9.0 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5.71, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.85, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.21, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.54 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.88, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BARIUM ENEMA (DOUBLE CONTRAST)", "code_information": [ { "code": "74280", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1008.7, "discounted_cash": 165.0, "minimum": 102.62, "maximum": 988.526, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 201.16 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 197.33 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 264.21, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 165.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 195.41 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 176.69, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 165.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 165.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 191.58 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 247.2, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 198.16, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 197.33 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 181.64, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 244.72, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 239.79, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "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 Duals", "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": 201.16 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 161.83, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.62 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 246.87, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "Bronchoscopy/lung bx each", "code_information": [ { "code": "31628", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1198.17, "discounted_cash": 3510.0, "minimum": 359.451, "maximum": 1198.17, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1198.17 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1198.17 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1198.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 1198.17, "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": 1198.17, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1198.17 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1198.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1198.17 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 1198.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 1198.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1198.17, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1198.17, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 1198.17, "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": 1198.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1198.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1198.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1198.17, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1198.17 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1198.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1198.17, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1198.17, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1198.17 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1198.17, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1198.17, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1198.17 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1198.17, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1198.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1198.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1198.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 1198.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1198.17 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1198.17, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1198.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1198.17, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1198.17, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BLASTOMYCES PRECIPITINS", "code_information": [ { "code": "86612", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 48.88, "discounted_cash": 12.0, "minimum": 7.0387, "maximum": 63.259, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.56 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.94 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 20.64, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.63 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.8, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 31.01 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.48, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.94 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.12, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.73, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "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 Duals", "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": 32.56 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.64, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.29, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BODY FLUID LDH", "code_information": [ { "code": "83615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9.0, "discounted_cash": 6.0, "minimum": 1.296, "maximum": 107.8, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 15.84, "10th_percentile": 15.84, "90th_percentile": 15.84, "count": "26" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 6.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 6.22, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 6.22, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.46, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 6.34, "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": 8.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 100.32, "10th_percentile": 100.32, "90th_percentile": 100.32, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 94.6, "10th_percentile": 94.6, "90th_percentile": 94.6, "count": "20" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 7.25, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6.64, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8.95, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 9.0 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 100.32, "10th_percentile": 100.32, "90th_percentile": 100.32, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 6.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.92, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.46, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.44 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.0, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BARIUM ENEMA AIR CONTRAST", "code_information": [ { "code": "74280", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1008.7, "discounted_cash": 165.0, "minimum": 102.62, "maximum": 988.526, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 264.21, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 165.13, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 176.69, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 165.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 165.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 239.44, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 247.2, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 198.16, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 181.64, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 244.72, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 239.79, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 165.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 161.83, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.62 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 246.87, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BRUCELLA IGM", "code_information": [ { "code": "86622", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 58.64, "discounted_cash": 8.0, "minimum": 7.5053, "maximum": 57.4672, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.56 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.94 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 14.29, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.63 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.56, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 31.01 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 13.37, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.94 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 9.82, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 13.23, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 12.97, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "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 Duals", "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": 32.56 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.75, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.04 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.35, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BODY FLUID SPECIFIC GRAVITY - 84315 - 3011207", "code_information": [ { "code": "84315", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 251.75, "discounted_cash": 3.0, "minimum": 2.95, "maximum": 246.715, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.58 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.26 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "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": 5.25, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.11 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 3.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 3.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3.51, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 3.44, "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": 4.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4.91, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 3.94, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.26 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.58 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.21, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.51, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.95 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.9, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BEHAVIORAL AND DEVELOPMENTAL DISORDERS", "code_information": [ { "code": "886", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16831.0, "minimum": 1066.0, "maximum": 26929.952, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Traditional", "methodology": "per diem", "standard_charge_dollar": 1066.0 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15152.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 15152.5, "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": 26929.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15152.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 15607.08, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 15607.08, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 24405.27, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16213.18, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 17672.78, "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": 21880.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15607.08, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 15152.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24405.27, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 15152.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20382.61, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 20197.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 26929.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 16667.75, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20178.95, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 19771.63, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16831.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12002.5 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 15152.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 25113.21 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 15152.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14849.45, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 16831.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 18009.41, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3492.88 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 20382.61, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "Bumex - 72205010207", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "72205010207", "type": "NDC" }, { "code": "J1939", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 10.01, "10th_percentile": 10.01, "90th_percentile": 10.01, "count": "1 through 10" } ] } ] }, { "description": "BLOOD COLL - OUTSIDE TESTING", "code_information": [ { "code": "36415", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 29.87, "discounted_cash": 9.0, "minimum": 3.55, "maximum": 40.1016, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 14.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.99, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 311.18, "10th_percentile": 67.42, "90th_percentile": 871.39, "count": "576" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 35.19, "10th_percentile": 9.09, "90th_percentile": 40.92, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 35.19, "10th_percentile": 32.63, "90th_percentile": 35.19, "count": "365" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 13.98, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 11.21, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 10.27, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 13.56, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 37.32, "10th_percentile": 37.32, "90th_percentile": 37.32, "count": "649" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.15, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.96, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BOLT,TITANIUM,LOCKING 458.XX", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "BEHAVIORAL DISORDERS - SOI : 2", "code_information": [ { "code": "7582", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 20819.276, "maximum": 22276.63, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 21860.24 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 21443.85 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 20819.28 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 21652.05 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 20819.28 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 21443.85 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 20819.28 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 20819.28 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 22276.63 } ] } ] }, { "description": "BUP/NALOXONE MS CONF UR", "code_information": [ { "code": "80348", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 165.0, "minimum": 23.436, "maximum": 161.7, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.49 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.68 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.47 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.28 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.47 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.68 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 40.47 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.47 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.49 } ] } ] }, { "description": "BLOOD CULTURE", "code_information": [ { "code": "87040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 265.0, "discounted_cash": 10.0, "minimum": 7.02, "maximum": 259.7, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.48 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 76.32, "10th_percentile": 14.0, "90th_percentile": 76.32, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.03 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "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": 16.51, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.36 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.81 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 10.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 10.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.96, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 488.66, "10th_percentile": 244.33, "90th_percentile": 488.66, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.04, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 10.84, "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": 14.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 28.0, "10th_percentile": 28.0, "90th_percentile": 28.0, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 416.43, "10th_percentile": 227.9, "90th_percentile": 429.16, "count": "11" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.96, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.36 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.45, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.03 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 11.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.29, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.36 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 483.36, "10th_percentile": 241.68, "90th_percentile": 483.36, "count": "15" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.48 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.11, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.04, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.29 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.43, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BONE AGE STUDY - 77072 - 3220069", "code_information": [ { "code": "77072", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 562.55, "discounted_cash": 98.0, "minimum": 10.83, "maximum": 771.8186, "payers_information": [ { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 147.33, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 118.1, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.57 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 108.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 145.86, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 142.92, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 80.09 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.45, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 105.31, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.83 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 147.14, "additional_payer_notes": "149.50% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 80.09 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.57 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "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": 157.47, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.81 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 101.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 101.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 142.71, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 105.31, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 103.34, "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": 137.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 168.77, "10th_percentile": 168.77, "90th_percentile": 168.77, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 142.71, "additional_payer_notes": "145.00% of Medicare Rates" } ] } ] }, { "description": "BEHAVIORAL DISORDERS - SOI : 3", "code_information": [ { "code": "7583", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 33309.23, "maximum": 35640.88, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 34974.69 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 34308.51 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 33309.23 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 34641.6 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 33309.23 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 34308.51 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 33309.23 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 33309.23 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 35640.88 } ] } ] }, { "description": "BUPRENORPHINE AND METABOLITE", "code_information": [ { "code": "80348", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 162.75, "minimum": 23.436, "maximum": 161.7, "payers_information": [ { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 40.47 } ] } ] }, { "description": "BLOOD DRUGS OF ABUSE, 8", "code_information": [ { "code": "80307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 224.44, "discounted_cash": 62.0, "minimum": 2.9664, "maximum": 1127.0, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.12 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.18 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 99.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.78 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.72 }, { "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 Duals - My Care", "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": 90.1, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 66.49, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": 87.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 14.17, "10th_percentile": 14.17, "90th_percentile": 17.72, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 90.1, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.78 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 93.02, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 74.57, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.18 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 68.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 92.09, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 46.78 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 90.23, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.78 }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.12 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.9, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.93 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 92.9, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BONE AGE STUDY - 77072 - 3240069", "code_information": [ { "code": "77072", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 787.57, "discounted_cash": 98.0, "minimum": 10.83, "maximum": 771.8186, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "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": 157.47, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 101.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 101.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 142.71, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 105.31, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 103.34, "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": 137.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 168.77, "10th_percentile": 168.77, "90th_percentile": 168.77, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 142.71, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 147.33, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 118.1, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 108.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 145.86, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 142.92, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.45, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 105.31, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.83 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 147.14, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC", "code_information": [ { "code": "726", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6220.0, "minimum": 3151.2, "maximum": 10800.0, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 5636.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 5636.21, "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": 9952.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5636.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 5805.3, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 5805.3, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 9019.35, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6030.74, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 6531.25, "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": 8086.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5805.3, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 5636.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9019.35, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 5636.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7532.71, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 7464.29, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 9952.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 6199.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7457.45, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7306.92, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6220.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3808.91 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 5636.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 8736.92 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 5636.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5523.49, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 6220.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 6655.66, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5218.38 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7532.71, "additional_payer_notes": "121.10% 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": 20598.087, "maximum": 22039.95, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 21627.99 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 21216.03 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 20598.09 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 21422.01 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 20598.09 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 21216.03 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 20598.09 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 20598.09 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 22039.95 } ] } ] }, { "description": "BLOOD GLUCOSE CHECK", "code_information": [ { "code": "82962", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15.95, "discounted_cash": 3.0, "minimum": 2.2968, "maximum": 15.95, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.95 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 4.59, "10th_percentile": 4.59, "90th_percentile": 4.59, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.95 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "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": 5.25, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.95 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 3.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 3.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3.51, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 3.44, "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": 4.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4.91, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 3.94, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.95 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.95 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.21, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.51, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.95 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.9, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BONE DISEASES AND ARTHROPATHIES WITHOUT MCC", "code_information": [ { "code": "554", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7067.0, "minimum": 3676.4, "maximum": 12600.0, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6396.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 6396.36, "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": 11308.53, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6396.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 6588.25, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 6588.25, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 10248.35, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6844.11, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 7421.22, "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": 9188.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6588.25, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 6396.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10248.35, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 6396.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8559.14, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 8481.4, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 11308.53, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 7036.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8473.62, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8302.58, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7067.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5437.67 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 6396.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 10045.04 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 6396.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6268.43, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 7067.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 7562.58, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7522.42 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8559.14, "additional_payer_notes": "121.10% 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": 88413.924, "maximum": 94602.9, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 92834.62 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 91066.34 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 88413.92 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 91950.48 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 88413.92 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 91066.34 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 88413.92 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 88413.92 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 94602.9 } ] } ] }, { "description": "BLOOD TRANSFUSION 1ST HOUR", "code_information": [ { "code": "36430", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1914.5, "discounted_cash": 415.0, "minimum": 407.0234, "maximum": 1940.2, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1914.5 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 1460.76, "10th_percentile": 1460.76, "90th_percentile": 1460.77, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1914.5 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 664.53, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1914.5 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1914.5 }, { "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 Duals - My Care", "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": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 1765.17, "10th_percentile": 1765.17, "90th_percentile": 1765.17, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 444.4, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 371.54, "10th_percentile": 371.54, "90th_percentile": 371.54, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 1914.5 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 621.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 498.4, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1914.5 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 456.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 615.52, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1914.5 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 603.1, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1914.5 }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 394.0, "10th_percentile": 394.0, "90th_percentile": 394.0, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 1914.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 407.02, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 620.92, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BONE MARROW IMAGING MULT AREAS", "code_information": [ { "code": "78103", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1943.4, "discounted_cash": 376.0, "minimum": 90.56, "maximum": 1904.532, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 439.13 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 430.77 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 376.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 376.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 602.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 418.22 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 376.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 426.58 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 387.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 387.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 545.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 402.71, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 395.18, "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": 526.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 376.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 376.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 545.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 418.22 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 376.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 563.41, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 451.63, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 430.77 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 414.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 557.77, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 418.22 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 546.51, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 418.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 376.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 376.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 376.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 439.13 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.83, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 376.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 402.71, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 90.56 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 562.66, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BETA G GLUCAN (FUNGITELL)", "code_information": [ { "code": "87449", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 275.0, "discounted_cash": 11.0, "minimum": 10.5264, "maximum": 294.9212, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.48 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 10.53, "10th_percentile": 10.53, "90th_percentile": 10.53, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.03 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 19.17, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.36 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.81 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.82, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 22.36 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.03 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.75, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.36 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.4, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.36 }, { "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 Duals", "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": 23.48 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.74, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.78 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.91, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "Bx of cervix w/scope leep", "code_information": [ { "code": "57460", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2790.05, "discounted_cash": 3047.0, "minimum": 837.015, "maximum": 2790.05, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2790.05 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2790.05 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2790.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 2790.05, "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": 2790.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2790.05 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2790.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2790.05 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 2790.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 2790.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2790.05, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2790.05, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 2790.05, "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": 2790.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2790.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2790.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2790.05, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2790.05 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2790.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2790.05, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2790.05, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2790.05 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2790.05, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2790.05, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2288.75 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2790.05, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2790.05 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2790.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2790.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 2790.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2790.05 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2790.05, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2790.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2790.05, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2790.05, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BNDG OPTFM SACRUM 7.9X7.2 IN", "code_information": [ { "code": "A6212", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 20.49, "10th_percentile": 20.49, "90th_percentile": 62.15, "count": "1 through 10" } ] } ] }, { "description": "BONE SCREW T10 3.5X50MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "BETA-2 GLYCOPROTEIN ANTIBODY", "code_information": [ { "code": "86146", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 910.0, "discounted_cash": 25.0, "minimum": 8.7912, "maximum": 891.8, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 40.72, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 27.23, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 36.9, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 38.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 30.54, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 28.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 37.72, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 36.96, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.94, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.91 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.05, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "C DIFFICILE TOXIN GENE NAA", "code_information": [ { "code": "87493", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 228.0, "discounted_cash": 37.0, "minimum": 26.8344, "maximum": 223.44, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 26.83, "10th_percentile": 26.83, "90th_percentile": 26.84, "count": "12" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 59.63, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.27, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 39.88, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 160.26, "10th_percentile": 160.26, "90th_percentile": 160.26, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 54.04, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 55.79, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 44.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 41.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 55.23, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 45.17 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 54.12, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 37.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.52, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.54 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 55.72, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BONE SCREW T10 F-T 3.5MM/L36MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "BETA-HCG_ QUANT", "code_information": [ { "code": "84702", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20.0, "discounted_cash": 15.0, "minimum": 2.88, "maximum": 25.59, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 2.88, "10th_percentile": 2.88, "90th_percentile": 2.88, "count": "37" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 20.0, "additional_payer_notes": "160.00% 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": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "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 Duals - My Care", "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": 20.0, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": 20.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 17.2, "10th_percentile": 17.2, "90th_percentile": 17.2, "count": "13" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 16.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "145.21% 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": 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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 18.24, "10th_percentile": 18.24, "90th_percentile": 18.24, "count": "15" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 20.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.75, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.55 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "C PNEUMONIAE IGM SERUM", "code_information": [ { "code": "86632", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 55.21, "discounted_cash": 12.0, "minimum": 7.3382, "maximum": 117.4922, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.56 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.94 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 20.29, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.63 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.57, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 31.01 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.98, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.94 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.41, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "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 Duals", "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": 32.56 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.43, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.41 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "149.50% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 55.2, "discounted_cash": 12.0, "minimum": 7.3382, "maximum": 117.4922, "payers_information": [ { "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.41 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "149.50% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.56 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.94 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 20.29, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.63 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.57, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 31.01 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.98, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.94 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.41, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "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 Duals", "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": 32.56 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.43, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BODY FLUID CHOLESTEROL", "code_information": [ { "code": "84311", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 97.35, "discounted_cash": 8.0, "minimum": 4.297, "maximum": 215.6, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.96, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 8.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 8.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.75, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.67, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 8.51, "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": 11.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.75, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 12.13, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 8.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11.76, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.94, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.67, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.29 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BONE SCREW T10 FT 3.5MM/L34", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "BETA-HYDROXYBUTYRATE", "code_information": [ { "code": "82010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 166.6, "discounted_cash": 8.0, "minimum": 7.35, "maximum": 163.268, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 13.07, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 12.23, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 9.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 8.99, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11.86, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.01, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.35 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.21, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "C PSITTACI IGG SERUM", "code_information": [ { "code": "86631", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 55.2, "discounted_cash": 11.0, "minimum": 4.2221, "maximum": 122.2942, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.56 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.94 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 18.91, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.63 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 31.01 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.69, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.94 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.52, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.16, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "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 Duals", "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": 32.56 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.58, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.64 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.67, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BODY FLUID CULTURE", "code_information": [ { "code": "87070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 219.41, "discounted_cash": 8.0, "minimum": 7.033, "maximum": 215.0218, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 31.6, "10th_percentile": 31.6, "90th_percentile": 31.6, "count": "65" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "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": 13.79, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 8.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 8.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.5, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 202.3, "10th_percentile": 202.3, "90th_percentile": 202.3, "count": "16" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 9.05, "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": 12.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 96.12, "10th_percentile": 65.82, "90th_percentile": 264.91, "count": "16" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 188.69, "10th_percentile": 188.69, "90th_percentile": 188.69, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 188.69, "10th_percentile": 175.87, "90th_percentile": 188.69, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.5, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.34, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 9.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 12.77, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.36 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 12.52, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 200.1, "10th_percentile": 200.1, "90th_percentile": 200.1, "count": "16" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.45, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.76 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.89, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BONE SCREW T10 FULL THRD 2.7/L", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "BG NON-LOCKING SCREW 2.5 X 14M", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "C. DIFF", "code_information": [ { "code": "87493", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 186.35, "discounted_cash": 37.0, "minimum": 26.8344, "maximum": 223.44, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 26.84, "10th_percentile": 26.83, "90th_percentile": 26.84, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 59.63, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.27, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 171.81, "10th_percentile": 171.81, "90th_percentile": 171.81, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 39.88, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 54.04, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 55.79, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 44.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 41.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 55.23, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 45.17 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 54.12, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 169.95, "10th_percentile": 169.95, "90th_percentile": 169.95, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 37.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.52, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.54 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 55.72, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "Bone biopsy trocarndl supfc", "code_information": [ { "code": "20220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1395.03, "discounted_cash": 1554.0, "minimum": 418.509, "maximum": 1395.03, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 542.58 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 532.24 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1395.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 1395.03, "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": 1395.03, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 516.74 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1395.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 527.07 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 1395.03, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 1395.03, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1395.03, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1395.03, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 1395.03, "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": 1395.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1395.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1395.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1395.03, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 516.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1395.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1395.03, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1395.03, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 532.24 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1395.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1395.03, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 516.74 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1395.03, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 516.74 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1395.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1395.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 1395.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 542.58 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1395.03, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1395.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1395.03, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1395.03, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BONE SCREW T10 FULL THREAD 3.5 - C1713 - 2784954", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "C. ESTER INHIB PROT", "code_information": [ { "code": "86160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 34.2, "discounted_cash": 12.0, "minimum": 2.052, "maximum": 891.8, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "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": 19.2, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 12.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.4, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.84, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 12.6, "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": 16.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.4, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.96, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.4, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.78, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.43, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.76, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.84, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.8 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.94, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BONE CEMENT R1X40 US REFOBACIN", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "BONE SCREW T8 FT 2.7MM/L20MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "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": 17630.0, "minimum": 6039.8, "maximum": 28209.584, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15869.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 15869.8, "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": 28209.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15869.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 16345.89, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 16345.89, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 25564.94, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16980.69, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 18512.54, "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": 22920.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16345.89, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 15869.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25564.94, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 15869.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21351.13, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 21157.19, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 28209.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 17456.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21137.79, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20711.12, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17630.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26487.4 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 15869.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 26347.51 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 15869.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15552.4, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 17630.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 18865.16, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 14695.97 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 21351.13, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "CA-125", "code_information": [ { "code": "86304", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23.5, "discounted_cash": 20.0, "minimum": 3.384, "maximum": 23.5, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.5 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 3.38, "10th_percentile": 3.38, "90th_percentile": 3.38, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.5 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 23.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.5 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.5 }, { "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 Duals - My Care", "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": 23.5, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 22.27, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": 23.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.5 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.5 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 22.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 23.5 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.5 }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 21.43, "10th_percentile": 21.43, "90th_percentile": 21.43, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 23.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.39, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.73 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BONE MARROW EXAM", "code_information": [ { "code": "85097", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 179.0, "discounted_cash": 758.0, "minimum": 25.776, "maximum": 179.0, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 179.0 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 179.0 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 179.0, "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": 179.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 179.0 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 179.0 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 179.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 179.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 179.0, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 179.0, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 179.0, "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": 179.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 179.0, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 179.0 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 179.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 179.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 179.0 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 179.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 179.0, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 179.0 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 179.0, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 179.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 179.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 179.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 179.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.0, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 179.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 179.0, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 179.0, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BONE SCREW T8 FULL 2.7/L10MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "BILIRUBIN, TOTAL BODY FLUID", "code_information": [ { "code": "82247", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 176.25, "discounted_cash": 5.0, "minimum": 4.52, "maximum": 172.725, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 8.03, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.37, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.28, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.02, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.44, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.29, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.92, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.52 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.5, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "CABLE READY GRIP SYSTEM ZIMMER", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "BONE MARROW IMAGING WHOLE BODY", "code_information": [ { "code": "78104", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1943.4, "discounted_cash": 376.0, "minimum": 124.03, "maximum": 1904.532, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 439.13 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 430.77 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 376.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 376.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 602.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 418.22 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 376.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 426.58 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 387.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 387.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 545.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 402.71, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 395.18, "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": 526.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 376.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 376.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 545.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 418.22 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 376.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 563.41, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 451.63, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 430.77 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 414.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 557.77, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 418.22 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 546.51, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 418.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 376.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 376.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 376.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 439.13 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.83, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 376.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 402.71, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 124.03 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 562.66, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BONE SCREW T8 FULL THREAD 2.7M - C1713 - 2782108", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "CALCITONIN", "code_information": [ { "code": "82308", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 32.0, "discounted_cash": 26.0, "minimum": 4.608, "maximum": 32.0, "payers_information": [ { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 32.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.45 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 29.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 32.0, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 29.56 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 32.0, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.56 }, { "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 Duals", "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": 31.04 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.25, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.11 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.0, "additional_payer_notes": "149.50% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.04 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.45 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 32.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.56 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.15 }, { "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 Duals - My Care", "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": 32.0, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 28.67, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": 32.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 32.0, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.56 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 32.0, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BONE SCREW FT T8 2.7MMX26MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "BONE SCREW T8 FULL THREAD 2.7M - C1713 - 2782115", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "BIOMENT BALL 163669", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 9453.57, "10th_percentile": 9453.57, "90th_percentile": 9453.57, "count": "1 through 10" } ] } ] }, { "description": "CALCIUM RANDOM URINE", "code_information": [ { "code": "82340", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10.0, "discounted_cash": 6.0, "minimum": 1.152, "maximum": 101.871, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 1.16, "10th_percentile": 1.16, "90th_percentile": 1.16, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 9.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.45, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 7.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8.94, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 10.0 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 9.12, "10th_percentile": 9.12, "90th_percentile": 9.12, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.91, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.43 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.01, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BONE SCREW T10 3.5X36MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "BONE SCREW T8 FULL THREAD 24MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "BIOMET 3.5 LOCKING SCREW", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "CANCELL SCREW,AFX,4.0X14", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "BONE SCREW T10 3.5X70", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "BIOMET 5.0 LOCKING BONE SCREW", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "CANCELL SCREW,AFX,4.0X42.5", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "BONE SCREW T10 F-T 3.5MM/L38MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "BPD & OTH CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD - SOI : 1", "code_information": [ { "code": "1321", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6214.545, "maximum": 6649.56, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 6525.27 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 6400.98 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6214.55 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 6463.13 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6214.55 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 6400.98 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6214.55 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 6214.55 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6649.56 } ] } ] }, { "description": "BIOMET ENDO TAPER NECK 13927", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 9453.57, "10th_percentile": 9453.57, "90th_percentile": 9453.57, "count": "1 through 10" } ] } ] }, { "description": "CANCELL SCREW,AFX,4.0X50", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "BONE SCREW T10 F-T 3.5MMX70MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" } ] } ] }, { "description": "BPD & OTH CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD - SOI : 4", "code_information": [ { "code": "1324", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 41220.763, "maximum": 44106.22, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 43281.8 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 42457.39 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 41220.76 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 42869.59 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 41220.76 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 42457.39 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 41220.76 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 41220.76 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 44106.22 } ] } ] }, { "description": "BIOMET HEAD/STD NECK", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 9453.57, "10th_percentile": 9453.57, "90th_percentile": 9453.57, "count": "1 through 10" } ] } ] }, { "description": "CANCELL SCREW,AFX,4.0X60", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "BONE SCREW T10 FULL 23.5/L14mm", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "BIOMET SSK SPLINED STEM", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 9453.57, "10th_percentile": 9453.57, "90th_percentile": 9453.57, "count": "1 through 10" } ] } ] }, { "description": "CANCELLOUS BONE SCREWS", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "BONE SCREW T10 FULL THREAD 3.5 - C1713 - 2784955", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "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": 27646.0, "minimum": 11554.4, "maximum": 44233.712, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 24851.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 24851.6, "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": 44233.71, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 24851.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 25597.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 25597.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 40086.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26591.21, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 29028.37, "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": 35939.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 25597.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 24851.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 40086.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 24851.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 33479.39, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 33175.28, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 44233.71, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 27336.76, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 33144.87, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 32475.84, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27646.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 43671.4 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 24851.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 41804.11 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 24851.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24354.57, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 27646.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 29581.29, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 15022.3 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 33479.39, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "CANCELLOUS SCREW 4.0X60MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "BONE SCREW T8 2.7 X 14MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "BRCAASSURE COMPREHENSIVE", "code_information": [ { "code": "81162", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7500.0, "discounted_cash": 1824.0, "minimum": 864.0, "maximum": 7350.0, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 947.87 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 929.81 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 2919.81, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 902.73 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1824.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 920.78 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1952.62, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1824.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 2250.0, "10th_percentile": 2250.0, "90th_percentile": 2250.0, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1824.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 902.73 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2731.85, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2189.86, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 929.81 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2007.37, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2704.47, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 902.73 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2649.91, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 902.73 }, { "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 Duals", "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": 947.87 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1788.38, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1642.39 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2728.2, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BIOPSY GUN", "code_information": [ { "code": "C1819", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3296.88, "10th_percentile": 3296.88, "90th_percentile": 6593.75, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 7432.02, "10th_percentile": 7432.02, "90th_percentile": 7432.02, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 3940.7, "10th_percentile": 3940.7, "90th_percentile": 3940.7, "count": "1 through 10" } ] } ] }, { "description": "CANCER ANTIGEN 15.3", "code_information": [ { "code": "86300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 46.44, "discounted_cash": 20.0, "minimum": 2.304, "maximum": 45.5112, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 2.88, "10th_percentile": 2.88, "90th_percentile": 2.88, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 33.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 22.27, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.15, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 24.97, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 22.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 30.84, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 30.22, "additional_payer_notes": "145.21% 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 Duals", "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": 20.39, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.73 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.11, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BONE SCREW T8 FT 2.7MM/L10MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CCMCC", "code_information": [ { "code": "584", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17344.0, "minimum": 4464.2, "maximum": 31263.2, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15612.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 15612.4, "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": 27750.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15612.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 16080.77, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 16080.77, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 25148.81, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16705.27, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 18211.21, "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": 22547.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16080.77, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 15612.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25148.81, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 15612.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21003.6, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 20812.81, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 27750.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 17173.64, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20793.73, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20374.01, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17344.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31263.2 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 15612.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 25904.61 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 15612.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15300.15, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 17344.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 18558.09, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 17864.84 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 21003.6, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "BIOPSY OF THYROID", "code_information": [ { "code": "60100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2896.7, "discounted_cash": 666.0, "minimum": 516.74, "maximum": 2896.7, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 542.58 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 532.24 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 1066.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 516.74 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 666.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 527.07 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 713.33, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 666.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 828.18, "10th_percentile": 828.18, "90th_percentile": 828.18, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 666.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 516.74 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 997.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 799.99, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 532.24 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 733.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 987.99, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 516.74 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 968.06, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 516.74 }, { "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 Duals", "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": 542.58 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 653.33, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 996.66, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "CANDIDA AB IGA", "code_information": [ { "code": "86628", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 64.59, "discounted_cash": 12.0, "minimum": 9.301, "maximum": 297.92, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 19.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.85, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.41, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.41, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.21, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.8, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.44, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.77, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.81 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.95, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BONE SCRW T10 FULL 3.5MM/18MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "BROAD STRAIGHT PLATE 6 HOLES", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "BIOSURE REGEN INT SCRW 10X25MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "CANDIDA SPECIES", "code_information": [ { "code": "87480", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 124.0, "discounted_cash": 20.0, "minimum": 3.7901, "maximum": 121.52, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.48 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.03 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 32.08, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.36 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.81 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.45, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 22.36 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 30.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 24.06, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.03 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 22.06, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 29.71, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.36 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 29.11, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.36 }, { "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 Duals", "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": 23.48 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.65, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.05 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.97, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BONE SURVEY COMPLETE - 77075 - 3240070", "code_information": [ { "code": "77075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1306.26, "discounted_cash": 98.0, "minimum": 47.25, "maximum": 1280.1348, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 201.16 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 197.33 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "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": 157.47, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 195.41 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 101.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 101.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 142.71, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 105.31, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 103.34, "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": 137.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 142.71, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 147.33, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 118.1, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 197.33 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 108.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 145.86, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 142.92, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 191.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 1191.31, "10th_percentile": 1191.31, "90th_percentile": 1191.31, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 201.16 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.45, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 98.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 105.31, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.25 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 147.14, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BROAD Y-PLATE 6 SHAFT STRYKER", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "CANNULATED SCREW T1 6.5X85MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "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": 22555.515, "maximum": 24134.4, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 23683.29 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 23232.18 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 22555.52 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 23457.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 22555.52 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 23232.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 22555.52 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 22555.52 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 24134.4 } ] } ] }, { "description": "BRONCHIOLITIS & RSV PNEUMONIA - SOI : 1", "code_information": [ { "code": "1381", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4645.546, "maximum": 4970.73, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 4877.82 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4784.91 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4645.55 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 4831.37 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4645.55 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 4784.91 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4645.55 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 4645.55 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4970.73 } ] } ] }, { "description": "BIPOLAR DISORDERS - SOI : 1", "code_information": [ { "code": "7531", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7271.034, "maximum": 7780.01, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 7634.59 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7489.17 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7271.03 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 7561.88 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7271.03 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 7489.17 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7271.03 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 7271.03 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7780.01 } ] } ] }, { "description": "CANNULATED SCREW,TI 4.0 X 40MM", "code_information": [ { "code": "C1716", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 511.0, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 1608.39, "10th_percentile": 1608.39, "90th_percentile": 1608.39, "count": "1 through 10" } ] } ] }, { "description": "BRAC1&2 UNCOM DUP", "code_information": [ { "code": "81213", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1125.19, "discounted_cash": 581.0, "minimum": 147.3368, "maximum": 2934.218, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 581.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 581.26, "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": 930.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 581.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 598.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 598.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 842.83, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 621.95, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 610.32, "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": 813.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 581.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 581.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 842.83, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 581.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 870.15, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 697.51, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 639.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 861.43, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 147.34 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 844.05, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 581.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 581.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 581.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 569.63, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 581.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 621.95, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 868.98, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BRONCHIOLITIS & RSV PNEUMONIA - SOI : 2", "code_information": [ { "code": "1382", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5989.76, "maximum": 6409.04, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 6289.25 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 6169.45 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5989.76 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 6229.35 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5989.76 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 6169.45 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5989.76 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 5989.76 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6409.04 } ] } ] }, { "description": "BLOOD CULTURE ROUTINE LABCORP", "code_information": [ { "code": "87040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 48.75, "discounted_cash": 10.0, "minimum": 7.02, "maximum": 259.7, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "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": 16.51, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 10.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 10.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.96, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.04, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 10.84, "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": 14.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.96, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.45, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 11.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.29, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.36 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.11, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.04, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.29 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.43, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "CAPILLARY BLOOD GAS", "code_information": [ { "code": "82803", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 120.92, "discounted_cash": 26.0, "minimum": 17.4125, "maximum": 129.164, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 41.71, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 27.89, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 113.35, "10th_percentile": 113.35, "90th_percentile": 113.35, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 37.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 39.03, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 31.28, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 28.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 38.64, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 28.03 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 37.86, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 120.2, "10th_percentile": 120.2, "90th_percentile": 120.2, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.46 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.97, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BRUCELLA IGG", "code_information": [ { "code": "86622", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 52.12, "discounted_cash": 8.0, "minimum": 7.5053, "maximum": 57.4672, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 14.29, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.56, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 13.37, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 9.82, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 13.23, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 12.97, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.75, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.04 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.35, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BLOOD DRAW FROM MEDIPORT", "code_information": [ { "code": "36591", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 545.15, "discounted_cash": 125.0, "minimum": 47.9881, "maximum": 534.247, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.39 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.43 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 200.4, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.99 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.95 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 134.02, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 47.99 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 150.3, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.43 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 137.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 185.62, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 47.99 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 181.88, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.99 }, { "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 Duals", "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": 50.39 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 122.75, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 187.25, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "CARBATROL LEVEL", "code_information": [ { "code": "80157", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 74.92, "discounted_cash": 13.0, "minimum": 10.7885, "maximum": 73.4216, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.83 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.34 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 21.2, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.09 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 24.6 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.84, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.9, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.34 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.58, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.64, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.24, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "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 Duals", "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": 25.83 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.99, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.93 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.81, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BUPRENORPHINE MAT 2 UR", "code_information": [ { "code": "80307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 400.0, "discounted_cash": 62.0, "minimum": 2.9664, "maximum": 1127.0, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 99.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": 90.1, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 66.49, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": 87.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 14.17, "10th_percentile": 14.17, "90th_percentile": 17.72, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 90.1, "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 93.02, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 74.57, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 68.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 92.09, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 46.78 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 90.23, "additional_payer_notes": "145.21% 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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.9, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.93 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 92.9, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BLOOD TRANSFUSION SERVICE", "code_information": [ { "code": "36430", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1940.2, "discounted_cash": 415.0, "minimum": 407.0234, "maximum": 1940.2, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 1460.76, "10th_percentile": 1460.76, "90th_percentile": 1460.77, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 664.53, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.33, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 1765.17, "10th_percentile": 1765.17, "90th_percentile": 1765.17, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 444.4, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 371.54, "10th_percentile": 371.54, "90th_percentile": 371.54, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 621.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 498.4, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 456.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 615.52, "additional_payer_notes": "148.20% 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": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 603.1, "additional_payer_notes": "145.21% 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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 394.0, "10th_percentile": 394.0, "90th_percentile": 394.0, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 407.02, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 620.92, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "CARBOFIX:PFT912250", "code_information": [ { "code": "C1769", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 904.16, "10th_percentile": 904.16, "90th_percentile": 904.16, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 3242.16, "10th_percentile": 3242.16, "90th_percentile": 3242.16, "count": "1 through 10" } ] } ] }, { "description": "BRAIN NATRIURETIC PEPTIDE", "code_information": [ { "code": "83880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 146.6, "discounted_cash": 39.0, "minimum": 21.1104, "maximum": 290.08, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 21.12, "10th_percentile": 21.11, "90th_percentile": 21.12, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 39.26, "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": 62.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 40.44, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 40.44, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 56.93, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.01, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 41.22, "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": 54.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 126.08, "10th_percentile": 118.71, "90th_percentile": 126.08, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 56.93, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 58.77, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 47.11, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 43.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 58.18, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 28.03 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.01, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 39.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 133.7, "10th_percentile": 133.7, "90th_percentile": 133.7, "count": "13" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 39.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.47, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 39.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 42.01, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.33 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 58.69, "additional_payer_notes": "149.50% 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": 46553.562, "maximum": 49812.31, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 48881.24 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 47950.17 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 46553.56 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 48415.7 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 46553.56 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 47950.17 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 46553.56 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 46553.56 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 49812.31 } ] } ] }, { "description": "CARBOXYHEMOGLOBIN", "code_information": [ { "code": "82375", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 54.59, "discounted_cash": 12.0, "minimum": 7.861, "maximum": 53.4982, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.6 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.11 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 19.71, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.87 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.18, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 24.38 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.44, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.11 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.55, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.26, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.89, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "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 Duals", "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": 25.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.07, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.09 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.42, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BRCA1 TARGETED ANALYSIS", "code_information": [ { "code": "81215", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1200.0, "discounted_cash": 375.0, "minimum": 147.3368, "maximum": 1176.0, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 154.71 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 151.76 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 375.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 375.25, "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": 600.4, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 147.34 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 375.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 150.29 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 386.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 386.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 544.11, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 401.52, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 394.01, "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": 525.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 375.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 375.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 544.11, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 147.34 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 375.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 561.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 450.3, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 151.76 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 412.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 556.12, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 147.34 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 544.9, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 147.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 375.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 375.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 375.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 154.71 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.75, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 375.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 401.52, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 337.73 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 561.0, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BX SOFT TISS LEG/ANK SUPERFIC", "code_information": [ { "code": "27613", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8891.1, "discounted_cash": 1554.0, "minimum": 1523.7726, "maximum": 8713.278, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3699.71 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3629.24 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 2487.79, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3523.53 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3594.0 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1663.71, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 3523.53 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2327.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1865.84, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3629.24 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1710.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2304.32, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1815.06 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2257.83, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3523.53 }, { "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 Duals", "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": 3699.71 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1523.77, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2324.53, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BODY FLUID CELL COUNT", "code_information": [ { "code": "89051", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 160.79, "discounted_cash": 5.0, "minimum": 5.04, "maximum": 157.5742, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.64 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 5.6, "10th_percentile": 5.6, "90th_percentile": 23.16, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.4 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 8.96, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.04 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.28 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.99, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 138.28, "10th_percentile": 138.28, "90th_percentile": 138.28, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8.38, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.4 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8.3, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 12.04 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8.13, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.04 }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 146.64, "10th_percentile": 146.64, "90th_percentile": 146.64, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 12.64 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.04 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.37, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARREST & SHOCK - SOI : 2", "code_information": [ { "code": "1962", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5535.694, "maximum": 5923.19, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 5812.48 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5701.76 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5535.69 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 5757.12 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5535.69 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 5701.76 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5535.69 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 5535.69 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5923.19 } ] } ] }, { "description": "BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "585", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15684.0, "minimum": 2888.6, "maximum": 29571.8, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14124.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 14124.4, "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": 25095.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14124.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 14548.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 14548.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 22743.11, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15113.11, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 16469.15, "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": 20390.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14548.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 14124.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22743.11, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 14124.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18994.41, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 18821.88, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 25095.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 15536.84, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18804.63, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18425.05, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15684.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29571.8 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 14124.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 23344.04 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 14124.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13841.91, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 15684.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 16782.84, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 10298.69 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18994.41, "additional_payer_notes": "121.10% 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": 4.66, "maximum": 134.5834, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.56 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 19.78, "10th_percentile": 19.78, "90th_percentile": 19.78, "count": "127" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.94 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 8.29, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.63 }, { "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 Duals - My Care", "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": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 126.62, "10th_percentile": 126.62, "90th_percentile": 126.62, "count": "18" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.54, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 125.24, "10th_percentile": 125.24, "90th_percentile": 125.24, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 118.1, "10th_percentile": 106.02, "90th_percentile": 118.1, "count": "16" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 31.01 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.94 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.68, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 125.24, "10th_percentile": 125.24, "90th_percentile": 125.25, "count": "43" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.56 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.66 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BODY FLUID RHEUMATOID HEMAGL.", "code_information": [ { "code": "86431", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20.6, "discounted_cash": 5.0, "minimum": 1.728, "maximum": 509.6, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.6 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 1.73, "10th_percentile": 1.73, "90th_percentile": 4.38, "count": "80" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.6 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.67, "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": 9.07, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.6 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.6 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.84, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 5.84, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.22, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 11.06, "10th_percentile": 11.06, "90th_percentile": 28.03, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.07, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 5.95, "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": 7.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 10.32, "10th_percentile": 10.32, "90th_percentile": 10.32, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.22, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.6 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8.49, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.6 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 20.6 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8.23, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10.94, "10th_percentile": 10.94, "90th_percentile": 10.94, "count": "17" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.07, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.1 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.48, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARREST & SHOCK - SOI : 3", "code_information": [ { "code": "1963", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7453.56, "maximum": 7975.31, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 7826.24 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7677.17 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7453.56 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 7751.7 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7453.56 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 7677.17 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7453.56 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 7453.56 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7975.31 } ] } ] }, { "description": "C-TELOPEPTIDE, SERUM", "code_information": [ { "code": "82523", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 226.44, "discounted_cash": 18.0, "minimum": 10.2888, "maximum": 221.9112, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 29.89, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.99, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 27.09, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.96, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.42, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 20.55, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.68, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.13, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.31, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.81 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.93, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "Bone biopsy open deep", "code_information": [ { "code": "20245", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1054.09, "discounted_cash": 2734.0, "minimum": 316.227, "maximum": 1054.09, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1054.09 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1054.09 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1054.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 1054.09, "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": 1054.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1054.09 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1054.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1054.09 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 1054.09, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 1054.09, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1054.09, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1054.09, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 1054.09, "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": 1054.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1054.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1054.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1054.09, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1054.09 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1054.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1054.09, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1054.09, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1054.09 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1054.09, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1054.09, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1054.09 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1054.09, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1054.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1054.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1054.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 1054.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1054.09 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1054.09, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1054.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1054.09, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1054.09, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS - SOI : 4", "code_information": [ { "code": "2014", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13995.702, "maximum": 14975.4, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 14695.49 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 14415.57 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 13995.7 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 14555.53 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 13995.7 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 14415.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13995.7 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 13995.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 14975.4 } ] } ] }, { "description": "BROAD Y-PLATE 3 SHAFT HOLES", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "C1q BINDING", "code_information": [ { "code": "86332", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 65.55, "discounted_cash": 24.0, "minimum": 9.4392, "maximum": 209.72, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.56 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.94 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 24.37, "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": 38.99, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.63 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.34, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 26.08, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 25.59, "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": 34.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 35.34, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 36.48, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 29.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.94 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 26.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 36.12, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 24.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.56 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.88, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 24.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 26.08, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.93 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.43, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BONE CEMENT SIMPLEX", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE- SOI : 2", "code_information": [ { "code": "1912", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7031.863, "maximum": 7524.09, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 7383.46 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7242.82 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7031.86 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 7313.14 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7031.86 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 7242.82 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7031.86 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 7031.86 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7524.09 } ] } ] }, { "description": "BRONCHIOLITIS & RSV PNEUMONIA - SOI : 3", "code_information": [ { "code": "1383", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9633.974, "maximum": 10308.35, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 10115.67 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 9922.99 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 9633.97 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 10019.33 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 9633.97 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 9922.99 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9633.97 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 9633.97 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10308.35 } ] } ] }, { "description": "C1Q COMPLEMENT", "code_information": [ { "code": "86160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 38.28, "discounted_cash": 12.0, "minimum": 2.052, "maximum": 891.8, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.56 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 3.28, "10th_percentile": 1.64, "90th_percentile": 20.58, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.94 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "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": 19.2, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.63 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 12.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.4, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 26.28, "10th_percentile": 26.28, "90th_percentile": 26.28, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.84, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 12.6, "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": 16.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.4, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.96, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.4, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.94 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.78, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.43, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 20.79, "10th_percentile": 20.79, "90th_percentile": 25.99, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.56 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.76, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.84, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.8 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.94, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BONE MARROW TISSUE CULTURE", "code_information": [ { "code": "88237", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 980.88, "discounted_cash": 143.0, "minimum": 40.2696, "maximum": 961.2624, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 230.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.75, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 153.81, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 208.44, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 215.19, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 172.5, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 158.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 213.04, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 81.59 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 208.74, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 143.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140.88, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 129.38 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 214.91, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE- SOI : 3", "code_information": [ { "code": "1913", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9368.728, "maximum": 10024.54, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 9837.16 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 9649.79 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 9368.73 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 9743.48 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 9368.73 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 9649.79 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9368.73 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 9368.73 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10024.54 } ] } ] }, { "description": "BRONCHITIS AND ASTHMA WITH CCMCC", "code_information": [ { "code": "202", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8174.0, "minimum": 3274.72, "maximum": 13078.672, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7388.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 7388.56, "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": 13078.67, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7388.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 7610.22, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 7610.22, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 11852.55, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7905.76, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 8582.88, "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": 10626.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7610.22, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 13050.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 13500.0, "10th_percentile": 13500.0, "90th_percentile": 13500.0, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 7388.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11852.55, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7388.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9898.92, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 9809.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 13078.67, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 8127.42, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9800.01, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9602.2, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8174.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7151.48 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 7388.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 11752.49 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 7388.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7240.79, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 8174.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 8746.36, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3274.72 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9898.92, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "CABLE PLUG 5.0MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "BONE SCREW 3.5MM X 26MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS - SOI : 3", "code_information": [ { "code": "1923", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13515.562, "maximum": 14461.65, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 14191.34 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 13921.03 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 13515.56 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 14056.18 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 13515.56 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 13921.03 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13515.56 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 13515.56 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 14461.65 } ] } ] }, { "description": "BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE 3RD DEGREE BURNS - SOI : 2", "code_information": [ { "code": "8422", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 26790.465, "maximum": 28665.8, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 28129.99 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 27594.18 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 26790.47 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 27862.08 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 26790.47 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 27594.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 26790.47 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 26790.47 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 28665.8 } ] } ] }, { "description": "CABLES 4 EXTEND GTR 5H23X261MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "BONE SCREW FULL THREAD 3.5MM X - C1713 - 2783136", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC", "code_information": [ { "code": "306", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12914.0, "minimum": 5120.7, "maximum": 20663.568, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11640.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 11640.0, "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": 20663.57, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11640.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 11989.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 11989.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 18726.36, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12454.8, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 13560.47, "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": 16789.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11989.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 11640.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18726.36, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 11640.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15639.74, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 15497.68, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 20663.57, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 12804.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15483.47, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15170.93, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12914.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16249.5 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 11640.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 19068.76 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 11640.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11407.2, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 12914.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 13818.76, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 17502.15 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15639.74, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "BX BREAST 1ST LES US IMG GUIDE", "code_information": [ { "code": "19083", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6877.5, "discounted_cash": 1554.0, "minimum": 1385.962, "maximum": 6877.5, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3559.25 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3491.45 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 2487.79, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3389.76 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3457.56 }, { "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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1663.71, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 3389.76 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2327.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1865.84, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3491.45 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1710.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2304.32, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1385.96 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2257.83, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3389.76 }, { "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 Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 2479.45, "10th_percentile": 2479.45, "90th_percentile": 2479.45, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "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": 3559.25 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1523.77, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2324.53, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "CALCULI", "code_information": [ { "code": "82365", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80.25, "discounted_cash": 12.0, "minimum": 11.556, "maximum": 78.645, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.6 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.11 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 20.64, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.87 }, { "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 Duals - My Care", "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": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 45.04, "10th_percentile": 45.04, "90th_percentile": 45.04, "count": "1 through 10" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.8, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "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": 24.38 }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.48, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.11 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.12, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.73, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "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 Duals", "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": 25.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.64, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.61 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.29, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BONE SCREW T 10FULL THD 3.5X24", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "CARDIAC DEFIBRILLATOR IMPLANT WITH MCC", "code_information": [ { "code": "276", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 47655.0, "minimum": 8140.6, "maximum": 76249.344, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 42797.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 42797.0, "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": 76249.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 42797.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 44080.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 44080.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 69100.97, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 45792.79, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 50038.63, "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": 61952.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 44080.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 42797.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 69100.97, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 42797.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 57711.22, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 57187.01, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 76249.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 47076.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 57134.59, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 55981.32, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 47655.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 36832.8 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 42797.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 72685.87 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 42797.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 41941.06, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 47655.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 50991.75, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 29744.96 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 57711.22, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "C DIFF AMPLIFIED PROBE REVOGEN", "code_information": [ { "code": "87493", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 186.35, "discounted_cash": 37.0, "minimum": 26.8344, "maximum": 223.44, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 26.83, "10th_percentile": 26.83, "90th_percentile": 26.84, "count": "12" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 59.63, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.27, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 39.88, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH HMO and PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 86.0, "median_amount": 160.26, "10th_percentile": 160.26, "90th_percentile": 160.26, "count": "1 through 10" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 54.04, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 55.79, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 44.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 41.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 55.23, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 45.17 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 54.12, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 37.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.52, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.54 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 55.72, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "CALR GENE VARIANT", "code_information": [ { "code": "81219", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 280.18, "discounted_cash": 121.0, "minimum": 40.3459, "maximum": 857.5, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 118.4 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 116.14 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 121.63, "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": 194.61, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.76 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 115.02 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 125.28, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 125.28, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 176.36, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 130.14, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 127.71, "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": 170.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 176.36, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.76 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 182.08, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 145.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 116.14 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 133.79, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 180.26, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 112.76 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 176.62, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.76 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 121.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 121.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 118.4 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 119.2, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 121.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 130.14, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 181.84, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "BONE SCREW T10 FT 3.5MM/L22", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "CARDIAC STRUCTURAL & VALVULAR DISORDERS - SOI : 4", "code_information": [ { "code": "2004", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 58363.766, "maximum": 62449.23, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 61281.95 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 60114.68 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 58363.77 }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "case rate", "standard_charge_dollar": 60698.32 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 58363.77 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 60114.68 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 58363.77 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 58363.77 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 62449.23 } ] } ] }, { "description": "C PNEUMONIAE IGG SERUM", "code_information": [ { "code": "86631", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 51.46, "discounted_cash": 11.0, "minimum": 4.2221, "maximum": 122.2942, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem 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 Duals", "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": 18.91, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.82, "additional_payer_notes": "100.00% 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 Duals - My Care", "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": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "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": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.14, "additional_payer_notes": "145.00% of Medicare Rates" }, { "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 (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.69, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.52, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.16, "additional_payer_notes": "145.21% of Medicare Rates" }, { "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 Duals", "methodology": "fee schedule", "standard_charge_dollar": 11.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.58, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "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": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.64 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.67, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "CANCELL SCREW,AFX,4.0X20", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "BONE SCREW T10 FULL THREAD 3.5 - C1713 - 2786111", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "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": 52114.0, "minimum": 6827.6, "maximum": 83383.856, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 46796.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 46796.1, "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": 83383.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 46796.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 48199.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 48199.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 75566.62, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 50071.83, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 54720.66, "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": 67749.38, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 48199.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 46796.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 75566.62, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 46796.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 63111.16, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 62537.89, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 83383.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 51475.71, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 62480.57, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 61219.38, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 52114.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 51346.9 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 46796.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 79567.71 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 46796.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 45860.18, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 52114.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 55762.95, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 35400.13 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 63111.16, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "C. DIFF CYTOTOXIN AB.", "code_information": [ { "code": "87230", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 292.5, "discounted_cash": 19.0, "minimum": 17.77, "maximum": 286.65, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.48 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.03 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "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": 31.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.36 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.81 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 20.33, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 20.33, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.62, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.12, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 20.73, "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": 27.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 28.62, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.36 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 29.55, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 23.69, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.03 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 21.71, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 29.25, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.36 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 28.66, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.48 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 21.12, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.77 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.51, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "CANCELL SCREW,AFX,4.0X38", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "description": "BONE SCREW T10 FULL THREAD 3.5 - C1713 - 2786112", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 93.5, "median_amount": 3592.66, "10th_percentile": 1802.82, "90th_percentile": 14278.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 92.2, "median_amount": 3141.3, "10th_percentile": 3141.3, "90th_percentile": 3141.3, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.2, "median_amount": 10369.6, "10th_percentile": 5631.6, "90th_percentile": 11447.06, "count": "1 through 10" } ] } ] }, { "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": 42372.0, "minimum": 7352.8, "maximum": 67796.304, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 38058.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 38058.9, "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": 67796.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 38058.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 39200.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "case rate", "standard_charge_dollar": 39200.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 61440.4, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 40723.02, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "case rate", "standard_charge_dollar": 44491.32, "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": 55084.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 39200.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 38058.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 61440.4, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 38058.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 51313.33, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 50847.23, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS", "methodology": "case rate", "standard_charge_dollar": 67796.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 41864.79, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 50800.62, "additional_payer_notes": "119.89% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 49775.2, "additional_payer_notes": "117.47% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 42372.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 51243.3 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 38058.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 64532.21 }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "case rate", "standard_charge_dollar": 38058.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 37297.72, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "case rate", "standard_charge_dollar": 42372.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 45338.78, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "case rate", "standard_charge_dollar": 34237.06 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 51313.33, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "C1, EST INHIB ACTIVITY", "code_information": [ { "code": "86161", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 77.36, "discounted_cash": 12.0, "minimum": 10.8, "maximum": 75.8128, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.56 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.94 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "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": 19.2, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.63 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 12.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.4, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.84, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 12.6, "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": 16.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.4, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.96, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.4, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.94 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.78, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.43, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.56 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.76, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.84, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.8 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.94, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ] }, { "description": "CANCER ANTIGEN 27.29", "code_information": [ { "code": "86300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16.0, "discounted_cash": 20.0, "minimum": 2.304, "maximum": 45.5112, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.4, "median_amount": 2.88, "10th_percentile": 2.88, "90th_percentile": 2.88, "count": "1 through 10" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "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": 16.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care source Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals - My Care", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "COMMUNICARE", "plan_name": "COMMUNICARE Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "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": 16.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health America", "plan_name": "Health America Coventry Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Medical Mutual of OH", "plan_name": "Medical Mutual of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange (04-21-2022 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN (FKA PRIVATE HEALTHCARE SYSTEMS)", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "PERENNIAL", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "148.20% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "145.21% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "UHC - VA CCN", "plan_name": "UHC - VACCN", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "West Virgina Medicaid", "plan_name": "West Virgina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "149.50% of Medicare Rates" } ] } ]